- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director, Inpatient Utilization Management ( UM ), leads and manages all utilization management ( UM ) functions for all ... include directing a clinical operations team designed to support the administrative functions. This role works closely with Medical Directors, and the… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation, ... reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops strategies to achieve departmental and CommonSpirit Health… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Chief Medical Officer (CMO) and is responsible for operational and administrative management of the Utilization Management ( UM ), Case Management (CM), and ... closely with the Chief Operating Officer (COO) to allow for integration with claims , appeals and grievances, and our customer service center. The COE ensures… more
- Fallon Health (Worcester, MA)
- …training is conducted so that office staff is able to complete daily billing and claims responsibilities + Works with FH UM , Provider Relations, and Claims ... to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief summary of purpose:** The… more
- University of Michigan (Ann Arbor, MI)
- …and privileging following strict requirements of Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), the National Committee for Quality ... of our patients and safeguard Michigan Medicine against loss of accreditation, malpractice claims , and claims of negligent credentialing. + Identifies red flags… more
- Providence (CA)
- …queues, and analyst metrics + Ensure appropriate review and payment of coding related claims in a timely fashion across all lines of business + Be responsible for ... review initiatives, driving toward new opportunities to implement appropriate coding UM controls + Be responsible for building and maintaining strategic internal… more