…transform healthcare? Bring your true colors to blue. The RoleThe MSK Clinical Utilization Reviewer - LPN is responsible for reviews of commercial members with

…was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals

…as a liaison with other medical organizations and community practices. - Support utilization management and clinical review activities. - Conduct chart reviews

…executes on all aspects of the health plan's medical policy, clinical utilization management programs and clinical benefit determinations. This role works closely

…Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical

…or needs. + Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries, limit

…the clients' responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every

…no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. Analyzes assessment data to

…(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services

…MD **Key Responsibilities:** Provides for the training of and ensures the effective utilization of team members. The director works closely with the CMO, CQO, CNO