- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ... currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical ... Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team… more
- Elevance Health (Norfolk, VA)
- …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
- Healthfirst (NY)
- …as assigned **Minimum Qualifications:** + Associates degree from an accredited institution + Registered Nurse ( RN ), Licensed Social Worker (LCSW or LMSW) ... key governance committee members. + Review the appropriate UM or related clinical and medical policies, job aids/procedures, and correspondence and make… more
- Apex Health Solutions (Houston, TX)
- …Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying with utilization review ... Summary: The UM Reviewer serves as a contact...as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for… more
- Magellan Health Services (Honolulu, HI)
- …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health...General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24… more
- University of Miami (Coral Gables, FL)
- …or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . NURSE ... for full- time positions at the Assistant/Associate/Full Professor of Clinical rank. UM is one of the...Conduct didactic, simulation, and clinical teaching and academic/ clinical advising of students in the doctoral nurse… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- Summary Registered Nurse ( RN ) Utilization Management ( UM ) delivers knowledge-based care to clients while developing technical skills. Assesses, plans, ... not limited to: The Nurse Utilization Management ( UM ) Registered Nurse ( RN...Criteria to perform complicated reviews while developing technical and clinical competencies. The UM RN … more
- AmeriHealth Caritas (Charleston, SC)
- …perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain requests for additional information and/or request ... is responsible for completing medical necessity reviews. ;Using clinical knowledge and experience, the clinician reviews provider requests...clarification. The BH UM Reviewer will use his/her professional judgment… more
- Molina Healthcare (Reno, NV)
- …+ Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member Assessment Team ... them. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and...medical or behavioral health settings. + Two years of clinical auditing/ review experience. **Preferred skills** : NCQA… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Nurse licensure in Pennsylvania or compact state license required. + 3+ years of clinical experience as a Registered Nurse required.; + Experience leading ... + 3+ years of experience performing utilization management reviews (prior authorization and concurrent review ) as a Registered Nurse within a managed care… more