- Commonwealth Care Alliance (Boston, MA)
- …will not be considered at this time._** Position Summary: Reporting to the Director , Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. ... Translate regulatory updates into operational actions, collaborating with Claims, Appeals, UM , and Provider Services. * Conduct internal audits and retrospective… more
- 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
- Ellis Medicine (Schenectady, NY)
- …or send for insurance denials or quality improvement organization appeals. + Assists UM Coordinator with data entry of insurance authorizations and denials. + Denial ... MD to MD reviews. + Performs audit activities under the supervision of the Director of Case Management and Social Work Services. Ellis Medicine is committed to… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity and coordination ... + Case Management Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required to know multiple functional… more
- Corewell Health (Farmington Hills, MI)
- …review cases for medical necessity, uses InterQual and/or other UR/ UM Committee-approved medical necessity screening criteria, when appropriate. Works ... of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. + Routinely communicates… more
- Griffith Company (Brea, CA)
- …version control of proposal files and ensure accurate final deliverables. + M aintain and updat er es um es , proj e ct des criptions, or gc har ts , and st andar d ... (signed only by our CEO, President, Executive Vice President or Human Resources Director ). No other Griffith Company employee is authorized to bind Griffith Company… more
- Corewell Health (Royal Oak, MI)
- …review cases for medical necessity, uses InterQual and/or other UR/ UM Committee-approved medical necessity screening criteria, when appropriate. Works ... of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. 5. Routinely communicates… more
- University of Michigan (Ann Arbor, MI)
- …new or revised document is completed by the CLIA Laboratory Director . 3. Provides advanced problem solving, troubleshooting, interpretation, consultation, and ... Time** Full-Time **Regular/Temporary** Regular **FLSA Status** Exempt **Organizational Group** Um Hospital **Department** MM Microbiol Pathology **Posting Begin/End Date**… more
- ULTRA ELECTRONICS OCEAN SYSTEMS INC. (Victor, NY)
- …front-end modules, and digital signal processing electronics. Reporting to the Director of Electrical Engineering, you would provide leadership that fosters ... project execution challenges + Ensure all staff and programs comply with UM US engineering processes, policies, and standards + Provide technical oversight and… more
- Highmark Health (Wexford, PA)
- …agency requirements **ESSENTIAL RESPONSIBILITIES** + Reviews pharmacy utilization management ( UM ) coverage requests and prepares such cases for clinical review ... by a pharmacist and/or medical director when required. (20%) + Within the context of the request, applies plan-specific benefits to each case appropriately,… more