- 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 ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… more
- CVS Health (Buffalo Grove, IL)
- … Clinical Operations, Clinical Account Management, Formulary Administration, and Clinical Affairs. The UM Clinical Development pharmacist may be ... more personal, convenient and affordable. **Position Summary** The Utilization Management ( UM ) clinical development pharmacist will develop clinically and… 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)
- …on dosing, indication, weight, BMI and other clinical considerations + Develop clinical criteria and medical policies for the review of medications + Ensure ... **Duties & Responsibilities:** + Monitor and review prior authorization requests for medications + Calculate...standing. + Work experience conducting prior authorization reviews + Clinical knowledge of pharmaceuticals and disease states in order… more
- Healthfirst (NY)
- …approvals from key governance committee members. + Review the appropriate UM or related clinical and medical policies, job aids/procedures, and ... spearhead the policy work that will inform Medical and Clinical strategy + Perform editorial formatting and review...ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. + Collaborate with… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas of BCBSMA. The physician ... determination depends, making reasonable efforts to obtain relevant information via UM clinical reviewers, peer-to-peer outreach, and/or direct provider EMR… 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 (Hartford, CT)
- …a part of our caring community and help us put health first** The UM Administration Coordinator 2 provides non- clinical support for the policies and procedures ... ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Primarily receive calls from Providers, Hospitals,… 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...review /precertification requirements. Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process to… more