- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for… more
- CommonSpirit Health (Phoenix, AZ)
- …creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials management. This role is critical ... meet the evolving needs of the healthcare industry and driving improvements in quality , patient satisfaction, and operational efficiency. As a member of the senior… more
- Sharp HealthCare (San Diego, CA)
- …support of program initiatives.Lead team members to facilitate and coordinate quality healthcare services and delivery of goods and services to meet a member's ... to Health Services teams.Attends and actively participates in department/team process/ quality improvement activities. + Program Improvement Maintains ongoing… more
- Corewell Health (Grand Rapids, MI)
- …in and guide population health initiatives including disease burden, value of UM /CM/ Programs , care management delegation when warranted, equity, SDOH, clinically ... and aligns with the overall Corewell Health system goals, including quality , affordability, equitable, safety and member experience. This position provides… more
- Houston Methodist (Katy, TX)
- …and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs . Collaborates with medical and clinical ... other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, Precertification and… more
- University of Southern California (Alhambra, CA)
- …services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team ... integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of post-hospital… more
- University of Miami (Miami, FL)
- … programs are used to train over 15,000 learners per year. Training programs include curricula developed by the UM Gordon Center, and other organizations, ... monitors data trends, and implements educational strategies to ensure compliance with quality standards. + Provides staff support in the development of patient care… more
- Blue KC (Workman, MN)
- …teaching to the member's knowledge level and learning style. + Meets individual quality performance standards and annual targets for program performance as ... authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside… more
- University of Michigan (Ann Arbor, MI)
- …to mentor and precept pharmacy residents within the Department's post-graduate educational programs . Quality Improvement + Develop and implement quality ... successful completion and submission of the following: + Completed application via the UM Careers website + Letter of intent + Updated curriculum vitae **Job… more
- University of Miami (Coral Gables, FL)
- …Office, etc.) to resolve compliance problems related to scholarly activities conducted at UM . + Develops and presents educational programs for groups and ... & Scholarly Activities Management (DSAM) Regulatory Analyst assists the DSAM Director with the development, oversight, and monitoring of compliance programs… more