- Sutter Health (Sacramento, CA)
- …years of recent relevant experience. * 2 years experience in Utilization Management ( UM ) and Clinical Denial Management Preferred **SKILLS AND KNOWLEDGE:** * ... Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance with current… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- The Cigna Group (Morris Plains, NJ)
- …is preserved + Act as a key collaborator with formulary strategy and clinical review teams to ensure alignment around GCN expansion, documentation requirements, ... key role in in ensuring that our utilization management ( UM ) policies align with clinical guidance, drive...level of review , and authorization duration requirement to drive a balance… more
- Evolent (Bismarck, ND)
- … clinical patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care environment** + **Cardiology and Oncology ... better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure notification… more
- University of Miami (Coral Gables, FL)
- …CTO is an enterprise level executive and will oversee all IT infrastructure services across UM and UHealth in support of education, clinical care , and research ... detailed plan process involving management staff, senior leadership and members of the UM 's clinical and educational communities. + Strong interpersonal and… more
- Humana (Montpelier, VT)
- …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
- Magellan Health Services (Honolulu, HI)
- …directly influence quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required ... Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse… more
- The Arora Group (Bethesda, MD)
- …Care Manager Certified (CMC) + Experience: + Referral Management/Utilization Management (RM/ UM ) experience. + Clinical subspecialty experience in Behavioral ... and cost-effective outcomes, across the continuum of care. + Serves as a clinical case manager and patient advocate, providing advanced practice clinical ,… more
- Humana (Lansing, MI)
- …explain the rationale behind utilization management decisions, + Work includes computer-based review of moderately complex to complex clinical scenarios, ... . At least 2 years of experience post-training providing clinical services . Experience in utilization management review... clinical services . Experience in utilization management review and case management in a health plan setting… more
- Elevance Health (Grand Prairie, TX)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… more