- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… more
- Integra Partners (Troy, MI)
- …and clinical processes + Develop and deliver comprehensive training programs for UM clinical staff on: + Writing clear and concise clinical ... educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The… more
- Elevance Health (Durham, NC)
- …medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer ... improve the delivery of care. **BH Care Manager I, UM /Crisis Line - North Carolina** Candidate must live AND...and substance abuse health benefits through telephonic or written review and providing clinical crisis support of… more
- Elevance Health (FL)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... PulsePoint office. This utilization management role is responsible for utilization management review for Behavior Analysis services. **How you will make an impact:**… more
- Independent Health (Buffalo, NY)
- …of post-graduate clinical experience in health care management and utilization review required; quality assurance and peer review experience preferred. + ... internal teams to support corporate HEDIS initiatives. + Support UM leadership to improve clinical service operations....initiatives. + Support UM leadership to improve clinical service operations. Serve on Independent Health committees as… more
- Healthfirst (NY)
- …developing clinical criteria, medical policies for provider administered medications, review of monthly reports for quality assurance, and staying current with ... medicine. + Work with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions Supervises, evaluates, and coordinates… more
- Munson Healthcare (Traverse City, MI)
- …The Physician Advisor functions as a peer to physicians and a consultant to PCM/ UM /CDI and administration. Conducts clinical review of cases referred by ... a resource to the Patient Care Management (PCM)/Utilization Management ( UM )/ Clinical Documentation Integrity (CDI) staff to promote...have been referred for consultation: + Assist staff with clinical review of patients and refer cases… more
- University of Miami (Miami, FL)
- …and Clinical Information Services (LRCIS) The University of Miami ( UM ) Libraries seeks nominations and applications for a creative, innovative professional to ... and Information Services Librarian of the Department of Learning, Research, and Clinical Information Services (LRCIS) on UM 's Medical Campus. Under the… more
- Humana (Guymon, OK)
- …provider calls to answer UM related questions and prepare authorization request for clinical review + Document calls and attach clinical information to ... care, or services for members. + Prepares and forwards authorization request to clinical review + Works within defined parameters to identify work expectations… more
- Humana (Lansing, MI)
- …support assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non- clinical support for ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM … more