- Virginia Mason Franciscan Health (Bremerton, WA)
- …more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation, ... reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops strategies to achieve departmental and CommonSpirit Health… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Chief Medical Officer (CMO) and is responsible for operational and administrative management of the Utilization Management ( UM ), Case Management (CM), and ... closely with the Chief Operating Officer (COO) to allow for integration with claims , appeals and grievances, and our customer service center. The COE ensures… more
- Fallon Health (Worcester, MA)
- …training is conducted so that office staff is able to complete daily billing and claims responsibilities + Works with FH UM , Provider Relations, and Claims ... to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief summary of purpose:** The… more
- University of Michigan (Ann Arbor, MI)
- …Worker's Comp insurances, PLA surg schedulers are the resource for the individual claims adjusters to contact when they need updated clinical information on a ... issues, in a timely manner. 6. Counsels' patient to contact the UM Financial Counseling Office to address questions regarding coverage, deductible, co-pay, and/or… more
- Molina Healthcare (Long Beach, CA)
- …**Job Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of ... appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership… more
- University of Michigan (Ann Arbor, MI)
- …and privileging following strict requirements of Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), the National Committee for Quality ... of our patients and safeguard Michigan Medicine against loss of accreditation, malpractice claims , and claims of negligent credentialing. + Identifies red flags… more