Outpatient UM Coordinator

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 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 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 DescriptionSummaryThe UM Member Liaison acts as an advocate on behalf of the member to address any concerns or questions they may have regarding their medical care relationship(s) with providers. The Liaison also works closely with the health plans with member assignment and access to care. The UM Member Liaison reports directly to the...

Utilizes decision-making and critical-thinking skills in the clinical review and determination of coverage for medically necessary health care services based on established hierarchy of criteria Knowledge of California Children Services (CCS) Knowledge of Health Plan DOFR's Maintain Compliance and CMS regulatory standards Follow UM Policies &...

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 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...

We are looking for Outpatient Coordinators to join our High Risk Case Management team . The Coordinator, Outpatient is responsible for coordinating non-clinical tasks to support the delivery of case to members who meet case management criteria. Responsibilities include but are not limited to assisting in scheduling medical appointments, durable medical...

Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (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...

Work Hours Monday Friday, 8:00am 5:00pm You can make a difference in peoples lives every day. When you join UCLA Health, youll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a...

Work Hours Monday – Friday, 8:00am – 5:00pm You can make a difference in people’s lives every day. When you join UCLA Health, you’ll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of...

Job DescriptionJob DescriptionThis position works collaboratively with other members of the Clinical Care Coordination team to ensure that authorization requests, provider and member inquiries are handled appropriately, within established timeframes and utilizing established guidelines. Duties and Responsibilities · Process incoming and outgoing faxes.·...

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...

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...

Work Hours Variable shifts, Monday Friday, 8am 5pm You can make a difference in peoples lives every day. When you join UCLA Health, youll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of...

Job DescriptionJob DescriptionSummaryThe Data Entry Clerk provides effective coordination by uploading clinical service requests into database. Communicates with IPA and Providers to ensure timely, accessible care/ services to members. Reports directly to the Outpatient Lead Coordinator under the guidance of the manager. The Data Entry Clerk adheres to MPM...

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 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,...