- Integra Partners (Troy, MI)
- …background combined with expertise in clinical documentation, medical necessity determination, regulatory compliance , and will be responsible for the design, ... our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM...but are not limited to: + Works with the Manager of Operations Training to develop an end-to-end training… more
- ManpowerGroup (Columbia, SC)
- **Title:** **Managed Care Coordinator UM II** **Location: Columbia SC (Onsite)** **Duration: 3 months** **Pay Range : $31/hr (On W2)** We are looking for a " ... **Managed Care Coordinator UM II** "to join one of our Fortune 500...and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.).… more
- Elevance Health (Indianapolis, IN)
- …discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, ... knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. **Required Qualifications** + Requires current… more
- Horizon Services, Inc. (Hayward, CA)
- …data used to enhance service delivery, QAQI functions, strategic planning, regulatory compliance , client outcomes, and client satisfaction. Coordinates with ... JOB TITLE: Compliance and Outcomes Manager LOCATION: East...management ( UM ) data for assigned program(s). Report UM data and make recommendations to Compliance … more
- Point32Health (Canton, MA)
- …and continuous process improvement activities. Report actual and potential risks for non- compliance to senior manager and lead mitigation planning activities. ... related to individual member coverage requests. Collaborate with Corporate Compliance on regulatory interpretation inquiries. Draft department responses… more
- AmeriHealth Caritas (Dublin, OH)
- …for the Ohio Market, this position is representing Utilization Management ( UM ) in state interactions/audits, validation of regulatory reporting/analytics for ... **Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical...Works in close collaboration with all departments to achieve regulatory standards and optimal departmental outcomes. Develops solutions that… 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
- Huron Consulting Group (Chicago, IL)
- …Manage Inpatient/Outpatient Surg Website Access and Rac Monitor Website Access to ensure regulatory compliance and up-to-date information. + Serve as a Resource ... while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and organizational policies. **Key… more
- University of Michigan (Ann Arbor, MI)
- …assurance, billing and distribution activities are performed and documented + Assure compliance with Pharmacy and regulatory agency standards + Interview and ... Pharmacy Manager Apply Now **How to Apply** Applicants will...submission of the following: + Completed application via the UM Careers website + Letter of Intent + Updated… 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
- Catholic Health Initiatives (Lexington, KY)
- …payer requirements, addressing denials effectively, and compliance with payer and regulatory requirements, and reviews and analyzes UM program outcomes and ... and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation, evaluation… more
- Crouse Hospital (Syracuse, NY)
- …to areas of responsibility and develops and implements strategies for compliance . The Manager works closely with the UM and Appeals and Denials staff as both ... The manager is the point person for problem escalation and troubleshooting for the staff. The Manager stays abreast of the regulatory environment specific… more
- University of Miami (Miami, FL)
- …Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Program Manager to work at the UHealth Medical Campus. The Research Program Manager ... evidence-based survivorship care program in federally qualified health centers. The manager will work in conjunction with the community program research coordinator… more
- BronxCare Health System (Bronx, NY)
- …on variances found. Conduct JCAHO preparation activities to insure hospital wide compliance and readiness. Assist in the design and implementation of educational ... Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and… more
- University of Michigan (Ann Arbor, MI)
- …of new equipment, supplies & reagents. **QC/QA/ Compliance ** 1. Monitor lab compliance with CAP, CLIA, and other regulatory requirements, and interact with ... On-site Phlebotomy Intermediate Manager Apply Now **How to Apply** A cover...supervisory and management experience. + Thorough knowledge of laboratory regulatory and compliance requirements. + Experience with… more
- University of Michigan (Livonia, MI)
- …their professional development. + Oversees the day-to-day operations of the ACU. + Ensures regulatory compliance with CMS, JC, CLIA, and other regulatory ... Admin Manager Assoc Healthcare Apply Now **Job Summary** The...Responsibilities + Regularly review ACU processes to ensure on-going compliance with institutional goals, objectives, policies, standards, and guidelines.… more
- University of Michigan (Canton, MI)
- …their professional development + Oversees the day-to-day operations of the ACU + Ensures regulatory compliance with CMS, JC, CLIA, and other regulatory ... Admin Manager Sr Healthcare Apply Now **Job Summary** The...Responsibilities** + Regularly review ACU processes to ensure on-going compliance with institutional goals, objectives, policies, standards and guidelines.… more
- University of Michigan (Ann Arbor, MI)
- …their professional development. + Oversees the day-to-day operations of the clinics. + Ensures regulatory compliance with CMS, JC, CLIA, and other regulatory ... Admin Manager Assoc Healthcare Apply Now **Mission Statement** Michigan...needed. + Regularly review clinic processes to ensure on-going compliance with institutional goals, objectives, policies, standards, and guidelines.… more