- Integra Partners (Troy, MI)
- …appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and ... UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse's responsibilities include but are not limited to:...medical necessity criteria + Refer cases to the Medical Director that do not meet … more
- HCA Healthcare (Englewood, CO)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...by the Case Management Direct and cover for the director as needed. This role is intended to mentor… more
- AmeriHealth Caritas (LA)
- …authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible to ensure that ... medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information...services and appropriately identify and refer requests to the Medical Director when indicated + Ensure the… more
- Corewell Health (Grand Rapids, MI)
- …Priority Health - 1231 E Beltline - Grand Rapids Department Name PH - Executive Medical Director Employment Type Full time Shift Day (United States of America) ... Medical Management and Rx Operations, including credentialing, formularies, UM /CM, member engagement, policy development / alignment / synchronization. + Partner… more
- Guthrie (Cortland, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... work within specified time frames. Knowledge of health benefit plans and related UM requirements preferred. Experience with CPT/ICD coding, medical record or… more
- University of Miami (Miami, FL)
- …in staff development and in-service training + Other duties as assigned by the UM COACH and PCIT Director Manuscript preparation: + Conduct literature reviews + ... information from planning meetings + Scores program metric measures + Enters UM COACH and PCIT related data into appropriate databases (eg, Children's Trust,… more
- University of Miami (Miami, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of Miami/UHealth Medical Training Lab at the Gordon Center is ... currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami,...per year. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more
- Saint Francis Health System (Tulsa, OK)
- …for individual patient situations, reporting them promptly to the Process Improvement/Quality Director , to appropriate clinicians and to the UM Manager. Reviews ... and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details… more
- CommonSpirit Health (Phoenix, AZ)
- …regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental ... + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational goals and regulatory standards.… more
- University of Maryland, Baltimore (Baltimore, MD)
- * Medical Director , Level III Neonatal Intensive...join UM -SJMC as the level III NICU Medical Director . This position requires someone with ... Care Unit* *University of Maryland St Joseph's Medical Center ( UM -SJMC) * *I. GENERAL SUMMARY*...and regulations. In addition to the administrative functions, the medical director is also expected to carry… more