- Cedars-Sinai (Beverly Hills, CA)
- …member eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors or Management. + Processes… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group...experience performing UM and CM at a medical group or management services organization. Experience with Managed… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social Services, Behavioral… more
- LA Care Health Plan (Los Angeles, CA)
- …the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director , and Chief Compliance Officer on other duties as assigned to support the ... and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit tools. Demonstrated experience… more