- Sutter Health (Santa Rosa, CA)
- …with the medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to develop and implement methods and ... Advisor (PA) conducts clinical reviews on cases referred by UM /CM staff and or other healthcare professionals to meet...to obtain query responses * Meets regularly with CDI Director , CDI Managers, and CDI Leads to understand current… more
- University of Michigan (Ann Arbor, MI)
- …PA, LPN and Nursing Leadership candidates with the greatest potential for success at UM Health. + Partner with nursing, APP and hiring leaders to assess staffing ... to recruit and ensure employer brand presence. + Act as a liaison with UM School of Nursing and develop partnerships with local and regional schools of nursing.… more
- University of Michigan (Dearborn, MI)
- …knowledge and management experience. **Who We Are** The University of Michigan-Dearborn ( UM -Dearborn) is one of the three campuses of the University of Michigan ... system. UM -Dearborn is a comprehensive university offering high-quality undergraduate, graduate,...(The Stamelos Gallery, Curator, Registrar). Reporting to the Associate Director , the LRC Head will provide strong leadership for… more
- University of Miami (Miami, FL)
- …guidance from the UM Diving Control Board and supervision of the Director of Scientific Diving, the Diving Safety Officer is responsible for the daily ... operation; will conduct full semester scientific diving courses, and supervise UM diver evaluation and training including coordinating and conducting scientific… more
- AmeriHealth Caritas (Newark, DE)
- …and/or provider appeals and grievance requests, including review of UM /claim denial reasons, contract/regulatory rules, benefits, and documentation received on ... making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support presenting cases and… more
- Blue KC (KS)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside ... date. + Intermediate level keyboarding skills + Intermediate level knowledge of FACETS UM , CM and claims applications. + Experience in working with Health and… more
- Corewell Health (Grand Rapids, MI)
- …including partnering with the care delivery system (internal and external) on UM /CM best practices and shared operations. + Maintain collaborative relationships with ... guide population health initiatives including disease burden, value of UM /CM/Programs, care management delegation when warranted, equity, SDOH, clinically oriented… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …+ Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity criteria and accreditation and regulatory criteria ... + Plan and scope deliverables with minimal support; keep project/ workgroup leads and Director informed of key issues/ risks and meet deadlines + Collaborate with … more
- Sharp HealthCare (San Diego, CA)
- …Will Do** Under the direction of the Sharp Community Medical Group (SCMG) Director for Health Service and in collaboration with the Health Services leadership team, ... legislative compliance for the division. Under the direction of the SCMG Director for Health Services, develops financial (budget) and operational strategy of HCM… more
- University of Miami (Coral Gables, FL)
- …institutions and Black communities. + At the direction of the Center director manages, implements, coordinates, plans and evaluates the business operations for the ... how to best execute the Center's plan. + Generates annual impact reports for Director 's review. + Oversees the review, approval and reporting of all expenditures to… more