UM Clinical Reviewer

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.Please read the following job description thoroughly to ensure you are the right fit for this role before applying.One of...

Job SummaryMolina Healthcare Services (HCS) is seeking a skilled Care Review Clinician to join our team. As a key member of our Inpatient Review team, you will play a critical role in assessing, facilitating, planning, and coordinating the delivery of care across the continuum for members with high need potential.Key ResponsibilitiesAssess inpatient services...

Job Title: UM Nurse, LVNJob Summary:The UM Nurse, LVN will be responsible for conducting prospective and retrospective reviews of requests for service authorizations to monitor the continuity and coordination of care. This position will also assist in the utilization of appropriate services and oversee the Prior Authorization Coordinators to direct...

Job SummaryMolina Healthcare Services (HCS) is seeking a skilled Inpatient Review Nurse to join our team. As a key member of our multidisciplinary team, you will work closely with members, providers, and other healthcare professionals to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum.Key ResponsibilitiesAssess...

Job SummaryUnder the general supervision of the UM Team Manager, this individual performs UM activities which include admission review, concurrent review, retrospective chart review and clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient's hospital stay or visit.Responsibilities include medical...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA***Position...

Job Title: Clinical Review CoordinatorWe are seeking a highly skilled Clinical Review Coordinator to join our team at Livanta LLC. As a Clinical Review Coordinator, you will play a critical role in supporting our physician reviewers and Medicare beneficiaries.Responsibilities:Perform desktop medical reviews and interpret coverage and payment policies,...

Job SummaryLivanta LLC, a Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization, is seeking a skilled Clinical Review Coordinator to join our Appeals Team in Virginia Beach, VA. As a key member of our team, you will play a vital role in supporting physician reviewers and communicating with Medicare beneficiaries, healthcare providers,...

Job SummaryLivanta LLC, a Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization, is seeking a skilled Clinical Review Coordinator to join its Appeals Team in Virginia Beach, VA. As a key member of the team, you will play a vital role in supporting physician reviewers and communicating with Medicare beneficiaries, healthcare providers,...

Job SummaryWe are seeking a skilled Clinical Review Specialist to join our team at Saviance Technologies. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive the right care at the right time.Key ResponsibilitiesConduct daily reviews and evaluations of members requiring hospitalization and/or...

Job Title: Clinical Hygiene PractitionerJob Summary:We are seeking a highly skilled Clinical Hygiene Practitioner to join our team at DCS Clinical. The ideal candidate will have excellent time management skills, be skilled in offering adjunctive services, and possess a positive attitude.Key Responsibilities:Perform all hygiene functions according to policies...

**JOB DESCRIPTION**Care Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a RN (Registered Nurse) who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role....

Job Title:Bariatric Clinical ReviewerJob Summary:Cabell Huntington Hospital is seeking a full-time Bariatric Clinical Reviewer for the Bariatric Surgery Department. The Clinical Reviewer will serve as the Metabolic and Bariatric Surgery Clinical Reviewer (MBSCR) and be responsible for collecting and submitting accurate, complete, and timely data into the...

Job SummaryWe are seeking a skilled Clinical Utilization Review Coordinator to join our team at Livanta LLC. As a key member of our Appeals Team, you will play a critical role in supporting physician reviewers and communicating with Medicare beneficiaries, healthcare providers, and other partners.Key ResponsibilitiesPerform desktop medical reviews and...

Job SummaryAdvanced Medical Manage is seeking a skilled Medical Case Manager to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring the continuity and coordination of care for our members.Key Responsibilities:Conduct thorough reviews of authorization requests to verify accurate provider...

Job Title: Clinical TherapistWe are seeking a highly skilled Clinical Therapist to join our team at Banyan Treatment Centers. As a Clinical Therapist, you will play a vital role in providing individualized care to our patients struggling with addiction and mental health issues.Job Summary:The Clinical Therapist will be responsible for conducting...

Job Title: Clinical TherapistWe are seeking a highly skilled Clinical Therapist to join our team at Banyan Treatment Centers. As a Clinical Therapist, you will play a vital role in providing individualized care to our patients struggling with addiction and mental health issues.Job Summary:The Clinical Therapist will be responsible for conducting...

The OpportunityQuidelOrtho unites the strengths of Quidel Corporation and Ortho Clinical Diagnostics, creating a world-leading in vitro diagnostics company with award-winning expertise in immunoassay and molecular testing, clinical chemistry, and transfusion medicine.We are a team of over 6,000 strong, operating in over 130 countries, providing fast,...

Job SummaryThe Clinical Utilization Review Specialist will be responsible for providing support services to ensure efficient authorization coordination, including registering patients, eligibility verification, scheduling patient visits, obtaining authorizations, and preparing billing data through data entry in EMR and 3rd party billing systems. The ideal...

Clinical Care ManagerCenters Plan for Healthy Living seeks a skilled Clinical Care Manager to oversee the delivery of quality healthcare services to patients. The ideal candidate will possess excellent organizational and communication skills, as well as the ability to assess data and interpret client needs.Key Responsibilities:Direct, supervise, and ensure...