UM Operations Clinical Guide

devoted · Operations · Live in: United States

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Posted 2026-10-19 · Verified 2026-10-31

The ad, in short

Job Description A bit about this role: The UM Operations Clinical Guide is a clinical nursing role responsible for supporting the quality, accuracy, compliance, and continuous improvement of Utilization Management (UM) operations within an assigned UM team. This position serves as the team’s clinical audit and monitoring resource, conducting Clinical Review audits, identifying trends and opportunities for improvement, and partnering with UM leadership to ensure processes and clinical decisions align with CMS requirements, regulatory standards, organizational policies, and established clinical criteria. In addition to audit and monitoring responsibilities, the UM Operations Clinical Guide... Read the full ad

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