- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical...Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- UPMC (Pittsburgh, PA)
- …Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization Management ... UPMC Health Plan members. They will oversee adherence to quality and utilization standards through committee delegations and further establish an effective working… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... will be ad hoc and required meetings onsite throughout the year. Summary The Director will be the department leader for system services for wholly owned and Partner… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford Macomb ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... join us. The Impact You Will Have As the Senior Director of Health Services, Utilization Management you will lead the design, strategic planning, evolution, and… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health ... quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management and care… more
- Tufts Medicine (Burlington, MA)
- …the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's strategy and ... as the internal resource on issues related to the utilization of resources, coordination of care across the continuum...of resources, coordination of care across the continuum and utilization review and management. The position develops and leads… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team ... of the following key health care services functions: care management, utilization management, care transitions, long-term supports and services (LTSS), behavioral… more
- Commonwealth Care Alliance (Boston, MA)
- …decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to… more
- UTMB Health (Galveston, TX)
- …of stay for all admissions. + Tracks and reports trends of inappropriate resource utilization to Director /Assistant Director of Utilization Management. + ... Utilization Review Case Mgr - Galv. Campus Utilization Mgt (10hr shifts) **Galveston, Texas, United States** Nursing & Care Management UTMB Health Requisition #… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …currently has an opening for Part-time Utilization Management Coordinator. The Utilization Management Coordinator will report to the Director of ... Utilization Review and will be responsible to provide quality case management services to all patients and their families, to serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy, and assure the… more
- Prime Healthcare (Inglewood, CA)
- …full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Humana (Montgomery, AL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- CVS Health (IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) ... CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). This is a remote based, work from home opportunity. The… more
- Humana (San Juan, PR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (Raleigh, NC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Bassett Healthcare (Cooperstown, NY)
- …secures financial and human resources for the department. Oversees and works with the Director of Utilization Management to support and implement the goals of ... best quality of life possible. What you'll do The director is responsible for the oversight of case management...the utilization management program. Maintains oversight responsibility for the discharge… more
- CVS Health (MI)
- …coordinate with the Medical Director and the Quality Improvement and Utilization Director and external parties on population health activities. **Required ... to effectively utilize these tools within the context of the Population Health Director role + Confidence working at home / independent thinker, using tools to… more