• Sr. Manager, Programs

    University of Miami (Miami, FL)
    …inquiries. Prepares, maintains, and reports on program effectiveness. Assists with managing program budget by monitoring expenditures. Stays abreast of market trends ... both online and residential, reports directly to the Associate Dean and inaugural director of online MPH, and offers administrative support for the design and… more
    University of Miami (04/29/25)
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  • Coord Appeals & Grievances

    AmeriHealth Caritas (Philadelphia, PA)
    …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... needed to ensure proper handling of the appeal eg UM team, medical directors, claims, contact center,...a facilitator or moderator /similar + Experience organizing and managing meetings. + Excellent verbal and written communication skills… more
    AmeriHealth Caritas (05/20/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    … staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
    Commonwealth Care Alliance (05/21/25)
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  • GME Program Administrator

    University of Miami (Miami, FL)
    …as a liaison between the Director of Program (Admin), Program Director (s), administrative leadership, UM /JMH Graduate Medical Education (GME) ... The incumbent oversees and coordinates the daily operations of assigned medical residency or fellowship program(s). The GME Program Administrator (A) supports… more
    University of Miami (04/07/25)
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  • Manager, Clinical Training Operations - Licensed…

    University of Miami (Miami, FL)
    …. The University of Miami/UHealth Gordon Center for Research in Medical Education is currently seeking a full time Manager, Clinical Training ... programs. An employee in this position supports their leader with managing assigned program components, preparing clinical training documentation, and preparing… more
    University of Miami (05/07/25)
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  • Behavioral Health UR Clinician

    Independent Health (Buffalo, NY)
    medical necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) ... standards set by regulatory and accreditation entities. + Refer appropriate cases to the Medical Director for review and work closely with Case Management to… more
    Independent Health (05/15/25)
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  • Manager, Programs (H)

    University of Miami (Miami, FL)
    …of tools for evaluating teachers, courses and resource materials; assisting in medical education research; managing and maintaining educational and clinical data ... The University of Miami/UHealth Gordon Center for Research in Medical Education is currently seeking a full time Manager,...year worldwide. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more
    University of Miami (04/17/25)
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  • Case Manager, RN or Licensed Behavioral Health…

    Excellus BlueCross BlueShield (Rochester, NY)
    …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable. +… more
    Excellus BlueCross BlueShield (05/22/25)
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  • Supervisor Quality RN

    Providence (Everett, WA)
    …and evaluation of appropriate services and resources to maximize optimum outcomes. The UM Supervisor assists the Washington NWR Director of Care Management in ... Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Washington...- they're invaluable. Join our team at Providence Regional Medical Center Everett and thrive in our culture of… more
    Providence (04/23/25)
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  • Clinical Social Worker MSW

    Corewell Health (Farmington Hills, MI)
    …status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. 5. ... hospital outpatient, observation or inpatient services. 4. May review cases for medical necessity, uses InterQual and/or other UR/ UM Committee-approved … more
    Corewell Health (05/21/25)
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