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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHPs 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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This position will also oversee delegate clinical and operational compliance with regulatory requirements and quality assurance initiatives related to utilization management out-patient activities.
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Supervise technicians engaged in maintaining the efficient operation of the ammonia refrigeration system, fire protection systems, HVAC systems, warehouse and dock equipment, material handling equipment, and storage racking; and the upkeep of the building components and grounds to promote safe, efficient, and optimal utilization of our facilities, equipment, and personnel.
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Dir Comprehensive Care Management (CCM) and Support Services is responsible for planning, developing, and implementing the continuum of care and case management functions of Baylor Scott and White Health (BSWH), which may include case management, social services, coordination of patient care, patient access, utilization management, and discharge planning.
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Minimum of 3-5 years as a pre-authorization or utilization review nurse in a payer or acute care setting; preferably medical-surgical or critical care/ED. Ability to conduct research regarding payer pre-authorization guidelines and applicable regulatory processes related to the pre-authorization process.
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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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Director Care Coordination- Major Responsibilites Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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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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The Solid Waste Division has a dedicated team of over 60 full-time positions assigned to several distinct areas: collections operations (refuse [trash], mixed recycling, and organic waste), landfill operations, street sweeping, regulatory compliance (both disposal and recycling diversion), and engineering, with a total annual operating budget of just over $15.4 Million.
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The Director LTC RN will actively participate as a member of Chiniak Bay Elder House Leadership Team and provide guidance about laws, rules and regulations pertaining to areas of work including but not limited to Utilization Review requirements as outlined in CMS Requirement of Participation (RoP) for long-term care and other regulatory guidance as applicable.
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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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The RN Case Manager Assistant is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements.
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Utilization of Sales Tax software applications, such as Vertex, Avalara. 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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Responsible for the sanitation and cleanliness of the facility, ensure food safety compliance and regulatory requirements are met within a meat processing manufacture. Incumbent will be required to complete Ammonia Refrigeration Operator II certification.
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