- Sharp HealthCare (San Diego, CA)
- …a timely manner in observance of regulatory requirements. Responsible for UM adverse determination letters to include ensuring compliance with appropriate ... and employer business practices. **What You Will Do** The UM Resource Coord-SCMG serves as a resource to the...taken related to the processing of the referral.Consults with supervisor , team lead and/or medical director to discuss requests/care… more
- Sharp HealthCare (San Diego, CA)
- …other services for post skilled nursing facility placement or home care. Ensures compliance with all applicable regulatory and health plan guidelines for ... Sharp Extended Care (SEC) provider on site and/or telephonically. Keeps SEC Nurse Supervisor or SEC provider of any adverse development, delay in discharge or… more
- LA Care Health Plan (Los Angeles, CA)
- …to support the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the ... of productivity and accuracy to achieve the department's overall performance metrics. The Supervisor ensures all functions of the UM department are operating in… more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor , Authorization Technician supports the Utilization Management ( UM ) Specialist by ... organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines. Ensure… more
- Dignity Health (Rancho Cordova, CA)
- …as required. - Implements the Departments Policies and Procedures to remain in compliance with Regulatory Agencies (DMHC, DHS, CMS, NCQA, ICE) - Supervises ... Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of… more
- LA Care Health Plan (Los Angeles, CA)
- …Utilization Management ( UM ) functions on behalf of LA Care (LAC) is in compliance with all UM regulatory requirements and new legislation through the ... requirements/new legislation. Works collaboratively with Regulatory Affairs & Compliance . Stay abreast of new UM legislation, regulations, or other… more
- LA Care Health Plan (Los Angeles, CA)
- …claims, appeals and grievances, and our customer service center. The COE ensures regulatory compliance , provides subject matter expertise to help oversight of ... and managed long-term supportive services, among other business processes. Assures compliance with all contracts and regulatory agencies [(eg, Managed… more
- Sharp HealthCare (San Diego, CA)
- …above standards.Keeps current knowledge and understanding of applicable accreditation and regulatory statutes related to health care, managed care, case management ... with Medical Directors, staff, physicians and their staff, hospital personnel, UM team, SRS CareManagement Programs and multidisciplinary team to facilitate positive… more
- Sharp HealthCare (San Diego, CA)
- …vendor list.Communicates the decisions to the appropriate persons and documents per UM policy. + Applies approved criteria to medical informationApply MCG formerly ... directors to medical information and authorized appropriate services/care.Consults with supervisor , team lead and/or medical director to discuss requests/care… more
- LA Care Health Plan (Los Angeles, CA)
- …created by the ECM Provider. Identify any gaps in the Care Plan services or regulatory compliance and provide coaching and feedback to the Provider to improve. ... LA Care's ECM network. The position reports to the Supervisor of ECM and receives clinical supervision as needed...to support effective delivery of ECM services and ensure compliance with local, State, and Federal regulations, statues and… more