- Sharp HealthCare (San Diego, CA)
- …ICM leaders to develop action plans at a system and local level to drive regulatory compliance . The ICM System Regulatory Specialist is the primary point ... 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); California... team. Tracks, trends and creates reports to ensure regulatory compliance and works closely with members… 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
- AmeriHealth Caritas (Newark, DE)
- …Chief Medical Officer for the Delaware Market, this position is representing UM in state interactions/audits, validation of regulatory reporting/analytics for ... **Utilization Management Plan Oversight Manager ** Location: Newark, DE Primary Job Function: Medical...Works in close collaboration with all departments to achieve regulatory standards and optimal departmental outcomes. Develops solutions that… 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
- LA Care Health Plan (Los Angeles, CA)
- …compliance with organizational standards, policies and procedures and regulatory requirements. Develops and implements approved departmental policies and ... Manager , Medical Management Job Category: Clinical Department: Utilization...and activities requiring clinical licensure in the Utilization Management ( UM ) department. This position will work closely leaders to… more
- LA Care Health Plan (Los Angeles, CA)
- …organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines. Ensure ... authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports. In addition,… 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
- Dignity Health (Rancho Cordova, CA)
- …as required. - Implements the Departments Policies and Procedures to remain in compliance with Regulatory Agencies (DMHC, DHS, CMS, NCQA, ICE) - Supervises ... **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible and accountable… 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
- Atlantic Health System (Morristown, NJ)
- The Utilization Management RN ( UM RN) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care and ... concurrent mitigation of denials. The UM RN maintains a strong knowledge base of evidence...cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as… more
- University of Michigan (Ann Arbor, MI)
- Program Manager - Term Limited Apply Now **How to Apply** A cover letter is required for consideration for this position and should be attached as the first page of ... Disease (DRD) Research Consortium. CDI is seeking a Program Manager to oversee the Mary Tyler Moore Vision Consortium...day-to-day operational and financial tasks in concert with the UM MTM Vision Consortium Faculty Director, the MTM Vision… more
- Dignity Health (Rancho Cordova, CA)
- …note: This position will involve rotating Saturday coverage.** **Position Summary:** The Manager of Utilization Management ( UM ) is responsible for managing the ... measure individual and team performance, clinical program performance, team processes and compliance are essential. Working with staff, the manager will… more
- LA Care Health Plan (Los Angeles, CA)
- …Management, Care Coordination and Special Programs Outreach. Responsibility includes regulatory compliance , accreditation compliance , oversight of ... compliance with organizational standards, policies and procedures and regulatory requirements. Assures department meets all regulatory time frames… more
- Healthfirst (New York, NY)
- …Director and/or UM Clinical Director requests. + Collaborate with the Regulatory , Compliance , Legal and Clinical departments to ensure deliverables adhere to ... of new processes related to these committees and facilitates improved regulatory compliance within the Clinical department. Duties/Responsibilities: + Support… more