- AmeriHealth Caritas (Orlando, FL)
- …of medical policy as it relates to health management. + Maintains compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and ... **Medical Director, UM Review, Family Medicine** Location: Orlando, FL Primary...quality and develop / implement process improvements to achieve regulatory and oversight compliance . **Diversity, Equity, and… 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
- Universal Health Services (Riverside, CA)
- …be responsible for improving membership retention, quality of care, health outcomes, and regulatory compliance , and utilization of services as it relates to ... is the best place to work, practice medicine, and receive care. SUMMARY: Manager with a health care system development and integration for the organization will… more
- University of Miami (Miami, FL)
- …working relationships and customer service. Ensures recovery was done in accordance with regulatory agencies' policies. + Ensures compliance with all OSHA and ... Recovery Coordinator 1 to work in Miami, FL. The Recovery Coordinator 1 ( UM LAORA) assists in the recovery, packaging, preservation and transportation of cadaveric… 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 ... Psychiatric Technicians -REQUIRED **Preferred Qualifications** + Experience as a case manager or discharge planner interacting with managed care payers. **Essential… more
- University of Miami (Miami, FL)
- …. The Manager , Compliance develops, implements, and oversees regulatory compliance strategies for the department. The incumbent on this position ... and is consistent with regulations. The Manager , Compliance also documents communications with investigators, regulatory ...the studies. + Train employees and colleagues on the UM and external IRB Electronic Protocol Submission and Tracking… more
- Houston Methodist (Nassau Bay, TX)
- …compliance with ethical and legal business practices and accreditation/ regulatory / government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Performs management ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and… more
- LA Care Health Plan (Los Angeles, CA)
- …to the needs of LA Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager ... appropriate supporting documentation. Monitors of staff's performance including productivity and compliance with regulatory requirements, compliance with… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare Operations (DHO) at Walter ... month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER (RN): The contracted RN shall provide the following...RN shall provide the following services and in strict compliance with standing orders and protocols set forth by… more
- Sharp HealthCare (San Diego, CA)
- … with clinical guidelines and standards.Ensures that Case Management staff is in regulatory compliance on a daily basis.Collects, reviews for accuracy and ... Do** Provide leadership and direct supervision for Utilization Management ( UM ) department staff. Accountable for results of the ...UM ) department staff. Accountable for results of the UM department as measured by monthly metrics and finance… more
- Point32Health (MA)
- …to optimize the quality of Program services; this involves ensuring compliance and validating interpretation with regulatory / contractual/ accreditation/ ... improve outcomes of assigned services such as CM and UM (Utilization Management). The Clinical Program Manager ...desirable + Leadership of programs / projects with an accreditation/ compliance / regulatory focus is preferred, preferably in a… more
- LA Care Health Plan (Los Angeles, CA)
- …the Compliance Advisor's primary responsibility is providing support and for the Regulatory Compliance unit, the Advisor also advises and supports the ... compliant with all Product Lines' contractual, state and federal regulatory , and accreditation requirements. The Compliance Advisor...Manager , Director, and Chief Compliance Officer on… more
- University of Miami (Miami, FL)
- …The Department of Pathology and Laboratory Medicine is currently seeking a full time Manager , Clinical Research to work in Miami, FL. The Manager , Clinical ... This role is also responsible for the independent execution of regulatory -related decisions/strategies; and coordinates work with Study Managers and other relevant… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …payer requirements, addressing denials effectively, and compliance with payer and regulatory requirements, and reviews and analyzes UM program outcomes and ... more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation,… more
- Highmark Health (Pittsburgh, PA)
- …teamwork, and organizational skills required + The ability to assist in ensuring compliance with regulatory agencies and HIPAA regulations required + Working ... of care. + Comply with regulations that impact on UM procedures and develop and implement processes that comply...and develop and implement processes that comply with all regulatory bodies, which include but are not limited to,… more
- Randstad US (Denver, CO)
- …statements and reports, ensuring the integrity of general ledger maintenance and regulatory compliance . location: Denver, Colorado job type: Permanent salary: ... technical accounting manager . + denver , colorado (remote) + posted...reports, ensuring the integrity of general ledger maintenance and regulatory compliance . Responsibilities + Oversee and ensure… more
- Sutter Health (Salt Lake City, UT)
- …and TJC. A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements. Must be able to effectively communicate with, and ... Health System Office-Valley **Position Overview:** This position facilitates utilization management ( UM ) processes to support that the right care is provided at… more
- University of Michigan (Ann Arbor, MI)
- …and orientation programs. + Responsible for dept.-wide communication. + Responsible for compliance with accreditation and regulatory requirements + Ensures the ... Central Sterile Supply Manager Apply Now **Summary** The Central Endoscope Reprocessing...for procedures, treatments, etc. are managed in accordance with regulatory and organizational standards and guidelines. This includes but… more
- University of Michigan (Ann Arbor, MI)
- …** Compliance , Safety and Quality Programs:** + Responsible for compliance with accreditation and regulatory requirements concerning the reprocessing ... Central Sterile Reprocessing Dept Manager Apply Now **How to Apply** A cover...for staff and leadership development. + Oversees and ensures compliance and training for the Instrument Tracking System. +… more
- Fallon Health (Worcester, MA)
- …Medicare, Medicaid, and PACE- in the region. **Brief summary of purpose:** The Manager works closely with their counterpart to assist the Senior Director, PACE ... Operations to manage the program level operational and regulatory functions related to Fallon Health's PACE programs. Responsible for compiling reports and analyzing… more