- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...and procedures. + Analyze data and generate reports on utilization trends, outcomes and quality indicators to support… more
- UPMC (Pittsburgh, PA)
- …UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... and procedures. + Contributes to process improvement within the Utilization Management department. + Participates in activities to support policy decision… more
- Integra Partners (Troy, MI)
- … (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… more
- LifeCenter Northwest (Bellevue, WA)
- …- $199,200.00 Salary Position Type Full Time Description and Qualifications The Director , Organ Utilization ( Director ), is responsible for overseeing ... of organ donation systems, allocation practices, and regulatory compliance. The Director develops and executes strategies to improve organ allocation strategy and… more
- Wellpath (Lemoyne, PA)
- …and point of care support . **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... life balance for team members and their family to support physical, mental, and financial wellbeing including: * DailyPay,...appropriate utilization of medical services. The Medical Director of Utilization Management serves… more
- Integra Partners (Troy, MI)
- …clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …and reporting, inform AI use cases, and performance monitoring frameworks** + ** Support organizational change management for UM modernization efforts, fostering ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes...Plan to perform medical review, obtains case or disease management support , or otherwise interacts with Health… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …the Associate Director of Patient Care Services (ADPCS). The Utilization Management /Float (RN) follows procedures per established policies and guidelines. ... Center is looking for recruit for Registered Nurse - Utilization Management / Float who is responsible...customer satisfaction throughout the continuum of care and float support . This position is located at the Miami VAHCS… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... Care Management I reports to the Care Management Director . **Position Details** + Full Time...Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred… more
- Actalent (Sacramento, CA)
- … Management Coordinator Job Description As a Utilization Management Coordinator, you will coordinate and support activities related to authorization ... for the UM/QM Supervisor, Manager, and/or Director of Medical Management . Responsibilities + Coordinate and support authorization processing for outpatient,… more
- Ascension Health (Austin, TX)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday, Days + **Location:** Remote + **Pay:** $93,857 - $126,983 + Eligible for ... + Two years of related experience is required. **Additional Preferences** + Utilization management experience strongly preferred. **Why Join Our Team** Ascension… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- Saint Francis Health System (Tulsa, OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... the role. ** Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- Huron Consulting Group (Chicago, IL)
- …regulatory agencies, and hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with hospital ... is located in Annapolis, MD + Staff Acquisition and Support : Leads and manages the utilization review...staff and function for the system, reporting to the Director of Utilization Management within… more