- 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
- Whidbey General Hospital (Coupeville, WA)
- …and background to assure compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning. The RN - Care Manager will lead ... regime, etc. The RN - Care Manager follows the hospital's Case Management/ Utilization Plan that integrates the functions of utilization review, discharge… more
- Alameda Health System (Oakland, CA)
- … information and reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of ... at Highland is responsible for the day-to-day operations of facility-wide utilization , discharge planning and care coordination. **DUTIES & ESSENTIAL JOB… more
- Independent Health (Buffalo, NY)
- … necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) services for ... procedure, identify, and refer potential quality of care and utilization issues to Medical Director ....annual program evaluations and Work Plans for the BH UM and/or CM Programs. + Aid department efforts with… more
- University of Miami (Miami, FL)
- …logistical knowledge of organ donation/recovery process in a timely manner. + Keeps UM LAORA Clinical Operations Director and Organ Allocation and Recovery ... responsible for all activities related to the allocation and utilization of organs from donors. Including, organ allocation for...of recovered organs when necessary. + Familiar with all medical aspects of organ donation and bring any questions… more
- AdventHealth (Orlando, FL)
- …relationships and share observations and provider improvement opportunities. Collaborates with Medical Director (s) to review and provide insight regarding ... teams. Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization ...concurrent review, and denials as a back up to UM Physician Advisory as and when needed. Assists with… more
- Cedars-Sinai (Torrance, CA)
- …specific to the department(s) below: **Department Duties and Responsibilities** ** Utilization Management** Maintain compliant UM processes that are ... **Job Description** **Job Summary: Key Job Responsibilities** The Executive Director is responsible for overseeing and providing strategic direction and vision to… more
- 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
- Highmark Health (Pittsburgh, PA)
- …reports to the Senior Vice President of Care Continuum and Transitions and the Medical Director of Physician Advisors. **Duties:** + The Physician Advisor works ... necessity. + When requested, discuss the case with the insurance company medical director to obtain payer authorization or conduct a peer-to-peer discussion… more
- WMCHealth (Valhalla, NY)
- …and problems. + Participates in daily review of aggregate denials/appeals with the Medical Director , peer, or the Clinical Review Supervisor. + Provides ... is responsible for developing positive relationships with both employed and affiliated medical staff members in order to fulfill strategic business growth and… more