- Harbor Health Services, Inc. (Mattapan, MA)
- …and appropriateness of care within a managed care environment. Additionally, the Director of UM ensures that collaborative relationships are maintained with ... those upon request of utilization or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate. Attends IDT meetings on… more
- Spectraforce Technologies (Columbia, SC)
- Role Name: Managed Care Coordinator UM II Location: Columbia, SC 29203 Work Environment: (Remote after 4-6 weeks of Onsite training) Schedule: Mon - Fri, 40hrs ... determinations. Identifies and makes referrals to appropriate staff (Medical Director , Case Manager, Preventive Services, Subrogation, Quality of care Referrals,… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... managed care and Medicaid policies and procedures D. Conducts staff and medical director audits on appeal activities + Assists with appeal file preparation for NCQA… more
- Alameda Health System (Oakland, CA)
- …time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, ... of utilization practices; assists physicians and hospital personnel in understanding UM matters. Perform all other duties as assigned. Prepares cost analysis… more
- Universal Health Services, Inc. (Sherman, TX)
- …States, Washington, DC, Puerto Rico and the United Kingdom. www.uhs.com The UM Supervisor oversees the utilization management of the Behavioral Health Center ... promotes patient satisfaction, regulatory compliance and optimal reimbursement. The UM Supervisor is responsible for attending or ensuring department representation… more
- Santa Clara Family Health Plan (San Jose, CA)
- …No. 521 GENERAL DESCRIPTION OF POSITION Under the guidance and direction of the UM department RN Manager or Director , the Utilization Management Review Nurse ... (LVN) performs prospective and retrospective clinical review for inpatient and outpatient authorization requests in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and applicable business requirements.… more
- San Francisco Health Plan (San Francisco, CA)
- Reporting to the Director of Clinical Operations, the Nurse Manager, Prior Authorizations, provides clinical and operational leadership to the Prior Authorizations ... (PA) team within the Utilization Management ( UM ) function. You will manage a team of registered nurses and clinical staff responsible for prior authorization… more
- Blue Cross and Blue Shield of Kansas City (Wichita, KS)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside ... hire date. Intermediate level keyboarding skills Intermediate level knowledge of FACETS UM , CM and claims applications. Experience in working with Health and… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …Portal - Texas Integrated Eligibility Redesign System (TIERS) + Supports the Medical Director throughout the EMR and State Fair Hearing process + Leads internal ... in the Utilization Management process_ + Delivers administrative support for the UM program by collecting member and provider information through phone, OnBase, CRM… more
- IPG Mediabrands (New York, NY)
- …globally on behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty business units Healix, ... the team. This person will work closely with the Director to help connect the client's MarTech and AdTech...behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty… more
- IPG Mediabrands (New York, NY)
- …globally on behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty business units Healix, ... contribute to an impactful communications/media plan. With direction from your Associate Director or Director , you take the strategic design imperatives… more
- Universal Health Services, Inc. (Newark, DE)
- …Rockford Center | Newark, DE Position Summary: The PRN Utilization Management ( UM ) Coordinator plays a critical role in ensuring appropriate and cost-effective care ... teams and insurance providers to support timely authorization of services. The UM Coordinator works on an as-needed basis, providing coverage during peak times,… more
- IPG Mediabrands (New York, NY)
- …globally on behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty business units Healix, ... paid media environments. Responsibilities Serve as a backup to the Associate Director for client relationships Collaborate with internal teams to align with and… more
- IPG Mediabrands (New York, NY)
- …globally on behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty business units Healix, ... excellence on a high-profile pharmaceutical account. Reporting to the Group Director of Client Operations, this role oversees day-to-day project management, process… more
- IPG Mediabrands (New York, NY)
- …contribute to an impactful communications/media plan. With direction from your Associate Director or Director , you take the strategic design imperatives ... client-facing category, culture and competitive tracking documents Work with the Associate Director and Partnerships team to develop the RFP to brief internal… more
- IPG Mediabrands (New York, NY)
- …contribute to an impactful communications/media plan. With direction from your Associate Director or Director , you take the strategic design imperatives ... client-facing category, culture and competitive tracking documents Work with the Associate Director and Partnerships team to develop the RFP to brief internal… more
- IPG Mediabrands (New York, NY)
- …align design with business goals and user needs. You will report into the Director of Product Design, supporting and leading a team designers across UX/UI and ... human-centered, accessible, inclusive and ethical design practices Work with the Director of Product Design on developing forward-looking, holistic design vision… more
- Santa Clara Family Health Plan (San Jose, CA)
- …TEMPORARY POSITION FLSA Status: Non-Exempt Department: Health Services Reports To: Director , Behavioral Health GENERAL DESCRIPTION OF POSITION The Behavioral Health ... psychiatric hospitalizations for members to obtain psychiatric/behavioral health care. Follow UM policies and procedures for new authorization requests. May conduct… more
- Central California Alliance for Health (Merced, CA)
- …involving an adverse benefit determination by an Alliance Utilization Management ( UM ) decision. Member Grievances (Complaints) : An oral or written statement ... serious threat to the health of the member, as determined by an Alliance Medical Director that includes, but is not limited to, severe pain, potential loss of life,… more
- IPG Mediabrands (New York, NY)
- …members to ensure flawless tactical execution. Responsibilities * Work with search director to develop campaign strategies and is responsible for the execution of ... globally on behalf of its clients across its full-service agency networks UM , Initiative and Mediahub and through its award-winning specialty business units Healix,… more
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