Inpatient UM Coordinator

Job DescriptionJob DescriptionSummaryProvides leadership, support, training, and direction to the Inpatient UM teammates. The incumbent will use clinical judgment to provide utilization management review for inpatient during high volume situations. Provide high quality, cost-effective care to enable patients to achieve maximum medical improvement, while...

Job DescriptionJob DescriptionSummaryThe Outpatient UM Coordinator provides effective communication between MSO, IPA providers, and members to coordinate member care. Communication to include accessibility to care, validating contract entities, and ensuring timeliness standards are met. The Outpatient UM Coordinator reports directly to the Outpatient Lead...

Job Description Job Description Under the general direction of the UM Delegation Specialist, the UM Delegation Coordinator is responsible for preparing, coordinating, and collaborating with UM and MPM departmental teams to facilitate delegated activities i.e. audit documents, regulatory reporting, and regulatory committee meetings. The UM DO Coordinator must...

Job Description Job Description Under the general direction of the UM Delegation Specialist, the UM Delegation Coordinator is responsible for preparing, coordinating, and collaborating with UM and MPM departmental teams to facilitate delegated activities i.e. audit documents, regulatory reporting, and regulatory committee meetings. The UM DO Coordinator must...

Job DescriptionJob DescriptionUnder the general direction of the UM Delegation Specialist, the UM Delegation Coordinator is responsible for preparing, coordinating, and collaborating with UM and MPM departmental teams to facilitate delegated activities i.e. audit documents, regulatory reporting, and regulatory committee meetings. The UM DO Coordinator must...

Job DescriptionJob DescriptionSummaryReporting to the Outpatient Lead Clinician, the Outpatient UM Clinician is responsible for assuring a thorough review of outpatient precertification/preauthorization referrals for those members identified as having the need for outpatient services. The OP UM Clinician works closely with Medical Director to determine and...

Job DescriptionJob DescriptionSummaryMedPOINT Management is committed to conducting its business and operations in accordance with the highest legal and ethical standards. Our Code of Conduct sets forth our expectations of management, employees, and contractors to act in accordance with applicable laws and Company policy. MedPOINT’s Compliance Department...

Job DescriptionJob Description SummaryReporting to the Outpatient Lead Clinician, the Outpatient UM Clinician is responsible for assuring a thorough review of outpatient precertification/preauthorization referrals for those members identified as having the need for outpatient services. The OP UM Clinician works closely with Medical Director to determine and...

Job DescriptionPosition Summary:The Inpatient Care Coordinator is responsible for supporting the process that manages all hospital and skilled nursing admissions, concurrent review, and discharge planning. The goal of the Inpatient Care Coordinator is to effectively support the in-patient management process by assuring the right information is provided...

Salary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Salary Range:  $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)   Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...

Job DescriptionJob DescriptionSummaryUnder the general direction of the Provider Network Operations (PNO) – Contracting Supervisor, the PNO Contract Coordinator is responsible for the managing and supporting the administrative and operational aspects of the PNO Contracting Team. This includes but is not limited to pre and post negotiation management,...

Job DescriptionJob Description MedPOINT Management (MPM)Department: Utilization Management (UM)Title Associate Medical Director SummaryThe Associate Medical Director is responsible for providing medical interpretation and decisions about appropriateness of services provided by other healthcare professionals in compliance with Utilization Management...

Job DescriptionJob Description MedPOINT Management (MPM)Department: Utilization Management (UM)Title Associate Medical Director SummaryThe Associate Medical Director is responsible for providing medical interpretation and decisions about appropriateness of services provided by other healthcare professionals in compliance with Utilization Management...

Job Description Job Description Summary Under the general direction of the Provider Network Operations (PNO) Contracting Supervisor, the PNO Contract Coordinator is responsible for the managing and supporting the administrative and operational aspects of the PNO Contracting Team. This includes but is not limited to pre and post negotiation management,...

Job DescriptionPosition Summary:The Inpatient Care Coordinator is responsible for supporting the process that manages all hospital and skilled nursing admissions, concurrent review, and discharge planning. The goal of the Inpatient Care Coordinator is to effectively support the in-patient management process by assuring the right information is provided...

Job Description Job Description Openings for both a Quality Compliance Nurse and a Compliance Coordinator. QUALITY COMPLIANCE NURSE PURPOSE: The Quality and Compliance Nurse is responsible for working with the Medical Director, the VP of Clinical Policy, the QM Committee in developing, implementing, and refining the Quality Management Program. They are also...

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...

Salary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Job DescriptionJob DescriptionOpenings for both a Quality Compliance Nurse and a Compliance Coordinator. QUALITY COMPLIANCE NURSEPURPOSE:The Quality and Compliance Nurse is responsible for working with the Medical Director, the VP of Clinical Policy, the QM Committee in developing, implementing, and refining the Quality Management Program. They are also...