- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator .** This role collaborates with clinical review staff, medical ... directors/physician reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals. Accurate documentation and detailed recordkeeping of notifications to members and network providers… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the CMHS. ... **ESSENTIAL DUTIES & RESPONSIBILITIES** + Act as coordinator /liaison with providers, staff and Managed Care Support Contractor...utilization management. + One (1) year of experience in UR/ UM and three (3) years of clinical nursing experience.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit ... verification, gathering necessary clinical information from electronic medical record, and timely communication with members, providers and facility staff. Candidates should possess knowledge of third-party reimbursement regulations and medical terminology.… more
- Centers Plan for Healthy Living (Margate, FL)
- …plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of ... members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in completing… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case ... Managers, support staff, insurance payers, and post-discharge vendors to ensure safe, timely, and efficient transitions of care. This coordination not only supports optimal patient outcomes but also helps ensure appropriate hospital reimbursement for services… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. ... The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer...Military referral processes, MOUs with MTFs, and referral and UM policies. + Answers questions or contacts MTFs and/or… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Health Support Coordinator Location: Remote Career Area: Customer Service/Operations About Blue Cross and ... to make a difference, join us. The Impact You Will Have The Health Support Coordinator (HSC) is a member of the Blue Cross Blue Shield of Minnesota (BCBSMN) Care… more
- Saint Francis Health System (Tulsa, OK)
- …and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details ... to the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager. Reviews eligibility and benefits of patients, matching the level of… more
- University of Michigan (Ann Arbor, MI)
- Career Services Coordinator **Early Site Maintenance** We are performing updates and maintenance to our applicant experience. As a result, the site will be ... of Michigan Law School invites applications for the Recruiting Coordinator in the Office of Career Planning. This role...+ Experience with Symplicity, Mailchimp, Concur, Qualtrics, Access, and UM systems is desired **Modes of Work** Positions that… more
