- MetroPlusHealth (New York, NY)
- …what you do every day. The Behavioral Health Utilization Management (BH UM ) Clinician is responsible for conducting utilization and quality management activities in ... InterQual with Secondary Dimensions & LOCADTR and OMH Criteria Sets Contributes to UM program goals and objectives in containing health care costs and maintains a… more
- Regal Medical Group, Inc. (Northridge, CA)
- Position Summary: The role of the Director , Prior Authorization Clinical RN is to manage the prior authorization nurse case managers and support staff ... (coordinators), professional claims review nurses and UM compliance staff to promote quality, cost effectiveness medical care through strict adherence to all UM … more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …pivot from a "job" opportunity to an authentic experience! The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and ... but are not limited to, case management, quality management, utilization management ( UM ), and grievance and appeals and committee participation. The Medical … more
- IPG Mediabrands (Los Angeles, CA)
- …are looking for a people-first organization that can offer you the career you crave, UM is your home. We are the destination of choice for the world's best talent, ... are hungry for personal growth and continuous learning. People who thrive at UM are collaborators by nature who pursue diverse perspectives because they understand… more
- Molina Healthcare (Long Beach, CA)
- …appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. Facilitates conformance to Medicare, Medicaid, NCQA… more
- White Plains Hospital - WH (White Plains, NY)
- …skills and expertise needed to manage the department, in conjunction with the UM manager and department director . Participates in and ensures department ... variances on a monthly basis, as required by the department director . Assures compliance with state regulations and accreditation standards. Ensures completion… more
- Blue Shield of California (San Diego, CA)
- Job Description Your Role The Behavioral Health (BH) Utilization Management ( UM ) team manages prior authorization and concurrent review for members seeking mental ... Specialist, Experienced will report to the Sr. Manager, BH UM . In this role you will be the subject...least two (2) times per month (for roles below Director -level) or once per week (for Director -level… more
- Children's Health (Dallas, TX)
- …* In collaboration with Patient Access Services, Ambulatory clinics and UM leadership planning and execution of communication to various facilities, developing ... education of nurse supporting role and established processes, works collaboratively with UM Denials Specialist to identify denial trends and provides feedback to… more
- UnitedHealth Group (Brooklyn, NY)
- …interdisciplinary teammates and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out patients' goals ... with hospital physicians following notification of member transfer Collaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for… more
- Thomas Jefferson University Hospitals, Inc. (Philadelphia, PA)
- …to review clinical information provided by facilities and communicates UM determinations maintaining timeliness. Job Description Primary Responsibilities: Review and ... care days and approve or refer questionable days to the medical director for decision. Function as a liaison between providers, members and interdepartmentally.… more
- The University of Miami (Coral Gables, FL)
- …and distributing to the department chair. *Collaborate with the Ungraduated Director to make grade changes, drop-adds, incomplete forms, faculties syllabi, and ... regularly updating department social media and website *In concert with UM , ensures Hurricane preparedness for the department, including maintaining up-to-date… more
- Liberty Health (Wilmington, NC)
- …and other documents incoming and outgoing. Assist Utilization Management RNs and Director with projects as needed. Attend and contribute to all internal Utilization ... Management meetings Ability to be an interactive UM team member to ensure compliant execution of ...UM team member to ensure compliant execution of UM program Review admissions and service requests for the… more
- University of Maryland Medical System (La Plata, MD)
- Company Description At University of Maryland Charles Regional Medical Center ( UM CRMC), our talented and diverse groups of professionals represent our strength. ... in a clean, orderly and safe manner according to established procedures; advises Director of equipment malfunctions. Maintains testing rooms and work area in a… more
- Regal Medical Group, Inc. (San Bernardino, CA)
- …indicated, they will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is ... When necessary, act as liaison between the case managers, UM coordinators, contracted providers (PCPs/specialists/ancillary), and the members/families. Perform case… more
- University of Maine System (Orono, ME)
- …as well as the state and local communities. Under the general direction of the Director of UM Center on Aging and AmeriCorps' program policy guidelines, the RSVP ... Director has fulltime responsibility for the development and operation...has been designated to handle inquiries regarding non-discrimination policies: Director of Equal Opportunity and Title IX Services, 5713… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management ( UM ) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... drive day to day operations and oversight of the UM program. + Lead, develop and manage processes to...provide guidance to assist in operational questions and/or escalated UM cases from delegates, Care Partners, Providers, and internal… more
- CVS Health (Springfield, IL)
- …regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" ... Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- University of Michigan (Flint, MI)
- …university advancement, student affairs, and community partners. This position reports to the director of the UM -Flint Office of Research. This is a term-limited ... health outcomes. By focusing primarily on collaborative research initiatives between UM -Flint faculty and the community, the Community-Engaged Program Manager will… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Central Clin Ops Leadership **Position Summary:** The Manager, Medical Policy reports to the Director of UM , and manages the personnel and work of the ... compliance with all regulatory, contract and NCQA requirements. + Together with the Director of UM and Sr. Medical Director of medical policy, manage the… more
