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The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management Out-Patient Operations departmental clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities (e.g., Prior Authorization, UM Call Center operations.
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The UMQM Nurse shall also participate in Utilization Management related activities with the Appeals and Grievance Department as well as the Compliance Department to assure that the quality compliance is being met for NCQA, state and federal regulatory requirements.
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RN Coordinator - Utilization Management & Discharge PlanningSummaCare - 1200 E Market Ave, Akron, OHPart-Time / 20 Hours / Days (2 days one wk / 3 days next wk)RemoteSummary:While taking direction from the Manager of UM, the UM Coordinator helps daily to prioritize, coordinate, and implement utilization, discharge planning, regulatory and compliance activities with the UM team.
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Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable.
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The Utilization Management Quality Management (UMQM) Nurse position is meant to ensure the quality of the work of the individuals in the Prior Authorization Department. This position reports to the Director of Utilization Management.
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Drive Computerized Maintenance Management System (CMMS) acceptance and usage to capture and quantify true costs of ownership, completion of recommended PM tasks, and regulatory compliance, prioritizing Watco's mission critical assets.
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The Software and Systems group within Tax Reporting & Strategy (TRS) offers management consulting services to clients and to their large corporate tax functions, by monitoring and analyzing legislative and regulatory tax developments, developing strategies in anticipation of tax law changes and regulatory developments, analyzing the economic impact of tax legislation and federal budget proposals, and addressing technology needs for tax function effectiveness.
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Thorough knowledge of quality assurance, quality improvement, utilization review, risk management, and accreditation and licensing requirements including The Joint Commission, NCQA, Knox-Keene Act, Federal HMO Act, CMS, Cal-OSHA, Public Employees Medical and Hospital Act, HIPAA and Medi-Cal regulations and standards.
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The Assistant General Counsel I supports and reports to the Chief Legal Officer and provides legal advice on a wide variety of matters related to Community's Medicare, Medicaid and Marketplace programs and operations including contracting, quality, utilization management, network management, privacy and security, litigation, fraud, waste and abuse, and contractual and regulatory compliance.
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Monitor and improve the operational performance of Water treatment facilities (UPW, Water Recycle, and Water transfer system) conducting daily, weekly, and monthly management of performance (cost and quality.
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Assist in the development of environmental management system to include to the standardization of decommissioning sites, utilization of water resources at sites, recycling and waste management for sites, procedures for fugitive emissions, and approaches to managing environmental risks.
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Maintain current knowledge, monitor changes, and provide research on Community's legal requirements including but not limited to licenses, certifications and accreditations as well as the requirements of the Texas Administrative Code, Texas Insurance Code, Health and Human Services Commission (HHSC), Texas Department of Insurance (TDI), Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), and other regulatory entities.
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Provide expert guidance and training to stakeholders on insider risk management best practices and the utilization of Proofpoint ObserveIT. Stay abreast of the latest insider risk trends, technologies, and regulatory changes to continuously enhance the institution's insider risk posture.
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The Program Manager possesses a deep understanding of enterprise risk management principles, regulatory compliance, and serves as the expert in implementation and utilization of GRC tools to streamline and enhance risk management processes.
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Training Required •California OSHPD Experience •State and/or Regulatory Agencies coordination related to Healthcare Construction Experience Training Preferred/Desired •Lean Process Improvement •Change Management •Design for Patient Focused Care •Evidence Based Design •RCDD •Sustainability.
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