- 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
- Lilly (Durham, NC)
- …Objectives/Deliverables:** + Enforce compliance to all procedures, methods, and other regulatory commitments as relating to EM/ UM , as well as applicable ... or Regulatory is desirable. + Understanding of regulatory standards / requirements for EM/ UM . +...Ability to focus on continuous improvement. + Understanding of compliance requirements and regulatory expectations for lab… more
- University of Michigan (Ann Arbor, MI)
- …duties include: * Develop policies and guidelines to improve standardization and maintain regulatory compliance in areas of oversight. * Monitor daily practices ... Pharmacy Technician Supervisor Apply Now **Mission Statement** Michigan Medicine improves...group and/or committees that address quality, cost containment, and regulatory compliance issues * Provide assistance to… more
- University of Michigan (Ann Arbor, MI)
- …interact with customers, public and staff. + Must require attention to legal and regulatory compliance issues. + Must be able to meet Physical requirements + ... service recovery + You will monitor and implement legal compliance measures **Required Qualifications Senior Supervisor +...and staff. + Must require attention to legal and regulatory compliance issues. + Must be able… more
- University of Michigan (Ann Arbor, MI)
- …work groups and committees addressing quality, cost containment and/or regulatory / compliance issues. **Mission Statement** Michigan Medicine improves the ... Pharmacy Technician Supervisor Apply Now **Summary** The Pharmacy Call Center...Certification** "The State of Michigan Department of Licensing and Regulatory Affairs (LARA) requires all Pharmacy Technicians to be… more
- University of Michigan (Ann Arbor, MI)
- …and participate in monitoring the laboratory Quality Assurance Program 5. Assist with compliance of regulatory agencies (ie, CLIA, CAP) rules and regulations and ... Clinical Microbiology Laboratory Supervisor Apply Now **How to Apply** A cover...short staffing situations. G. Quality Assurance, Quality Control and Compliance 1. Responsible for monitoring test analyses and specimen… more
- Highmark Health (Columbus, OH)
- …systems and databases, focusing on productivity, quality and compliance . + Ensure compliance with all regulatory entities (ie, DOH, CMS, NCQA, etc.) Create, ... and coordinates the day to day activities of the UM Intake Coordination team. The incumbent selects, develops and...compliance standards are met. Represent the department in compliance audits as it relates to the supervisor… 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
- The Arora Group (Bethesda, MD)
- …CASE MANAGER (RN): The contracted RN shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF and IAW JC ... guidelines to provide access to available programs. + Ensure guidelines are in compliance with case management standards of practice. + Propose regulatory and… more
- University of Miami (Miami, FL)
- …in planning/performing research protocols for optimal quality research. 2. Research Regulatory Compliance and Human Subject's Protection + Follows fundamentals ... scheduling, and research subject interfacing. 2. Tracks medical reports and reviews regulatory documents to generate reports. 3. Serves as project liaison to other… more
- Molina Healthcare (Dallas, TX)
- …auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), ... Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May...approach and tool use. + Assists in preparation for regulatory audits by performing file review and preparation. +… 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
- University of Miami (Miami, FL)
- …and participates in continuing education activities and events. + Monitors employee compliance with approved regulatory and departmental guidelines. Assists in ... between 11:00pm and 7:30am or as assigned by your supervisor . Diligently manages and supervises all cadaveric donor testing...laboratory leadership and Medical Director in being responsible for compliance with Safety Protocols within UM and… 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
- University of Michigan (Ann Arbor, MI)
- …Pathology Operations Director. An in-depth understanding of Transfusion Medicine technical, regulatory , and compliance matters will be expected. **Mission ... procedures established either by the laboratory director or technical supervisor . + Keep staff informed of all new policies...supplies & reagents. **QC/QA/ Compliance ** + Monitor lab compliance with CAP, CLIA, AABB, and other regulatory… more