- 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
- MetroPlusHealth (New York, NY)
- …understanding of Utilization Management and the role of a Medical Director , including regulatory requirements. Prior UM administrative coordination experience ... as the information gateway to facilitate interdepartmental communications across all UM . The Clinical Operations Coordinator will assist in the management of… 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
- Franciscan Missionaries of Our Lady Health System (Jackson, MS)
- …followed by appropriate intervention as evidenced by documentation. e. Prompt notification of UM Manager or Director of possible quality or physician issues as ... for services provided are validated within the timeframe outlined in UM Department SOP and/or Payor Plan Guidelines. b. Communicates accurate information… 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
- UnitedHealth Group (Phoenix, AZ)
- …Connecting. Growing together. We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting ... in all required software and platforms Although the United Health Services ICM Medical Director 's work is typically concentrated in a region, they are part of a… 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
- University of Maryland Medical System (Bel Air, MD)
- Company Description University of Maryland Upper Chesapeake Health ( UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical ... as a resource for health promotion and education. Today, UM UCH is the leading health care system and...by: RN / Charge Nurse / Nurse Manager / Director / AVP of Nursing Supervision provided to: None… 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
- CenCal Health (Santa Barbara, CA)
- …Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, care ... working with internal and external groups Conducts clinical reviews and makes UM decisions for prior, concurrent (hospital/ skilled nursing facility) and retro… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria and accreditation and regulatory ... Plan and scope deliverables with minimal support; keep project/ workgroup leads and Director informed of key issues/ risks and meet deadlines Collaborate with … 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
- The University of Miami (Miami, FL)
- …ADDENDUM Department Specific Functions Provide support for Radiology Division director and it's division members: Travel Requests and Business Reimbursements: ... for assigned faculty members. Administrative Support: Assist in faculty on-boarding (ID Badge for UM and JHS, access, lab-coats, Scrub access At UM and JHS… more
- University of Michigan (Ann Arbor, MI)
- …including operational, procurement, facilities and HR support. Reporting to the Deputy Director , the ideal candidate will provide administrative support to the OUA ... Serves as backup to Executive Secretary for the AVP/Executive Director of Undergraduate Admissions. Coordinates monthly department-wide staff meetings; partners… 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
