- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact...utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying ... or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in need of case/disease management… more
- Cleveland Clinic (Cleveland, OH)
- Utilization Management ( UM ) RN Reviewer Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. ... respected healthcare organizations in the world. Utilization Management RN Reviewers perform UM activities including admission review , concurrent review ,… more
- 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 ultimate ... for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage… more
- Magellan Health Services (Honolulu, HI)
- …influence quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical ... Work Experience - Preferred Education - Required Associate - Nursing, Bachelor's - Social Work, Master's - Social Work Education - Preferred License and Certifications - Required CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed… more
- The Cigna Group (Bloomfield, CT)
- …cases for impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit clinical information and ... facilitate discharge planning. + Identified all cases appropriate for inpatient case management interventions, initiates and discusses options for discharge planning with the facility, provider, vendor, member and/or family and documents interactions and… 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 ... clarification. The BH UM Reviewer will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas ... help us transform healthcare? Bring your true colors to blue. The physician reviewer is responsible for evaluating pre & post-service clinical service requests made… more
- Molina Healthcare (Manhattan, NY)
- …looking for a candidate with a LPN licensure. Experience with Utilization Management ( UM ) is highly preferred. Remote position in New York state Work hours: Monday ... teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other...social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital… more
- CVS Health (Buffalo Grove, IL)
- …coverage programs in support of prior authorization, step therapy, quantity and formulary review programs for CVS Health. The UM pharmacist will participate in ... personal, convenient and affordable. **Position Summary** The Utilization Management ( UM ) clinical development pharmacist will develop clinically and ethically based… more
- Humana (Hartford, CT)
- …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