- Merck & Co. (North Wales, PA)
- …EDSA review process. Manages programs (patient support, educational or risk management ) to support appropriate and safe utilization of Our Company medicines ... Job Description Role Summary: The Global Senior Director Medical Affairs (GDMA) is a subject matter...in collaboration with RDMAs, while also serving as a review panel member on TA specific MISP's to support… more
- Insmed Incorporated (NJ)
- …A successful candidate will provide knowledge, understanding, interpretation, and utilization of regulatory guidance and regulations from various health authorities, ... drug products worldwide with the flexibility for post-approval maintenance and lifecycle management of the marketed products.Develop plans for the preparation of CMC… more
- Merck & Co. (Rahway, NJ)
- …members and partner groups including formulators, engineers, Quality, Safety, and Facilities management to drive overall success and performance of the area and ... quantities, equipment used, and environmental conditions.Tactical and strategic shift management , including collaboration with indirect staffBatch Adaptability: Quickly adapt… more
- MetroPlusHealth (New York, NY)
- … activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures for diversionary services including, ... (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review , quality assurance, discharge planning. (Experience working in a… more
- MetroPlusHealth (New York, NY)
- …other MetroPlusHealth departments with resolution of member concerns related to retention, utilization management , quality management , customer service, and ... strong relationships with its members and providers.Position OverviewUnder the direction of the Director of Care Management (PIC), the PIC Clinical Care Manager… more
- Jefferson Health (PA)
- …for a Lead Advanced Practice Clinician (APC) who will provide supervision and management of advanced practice clinicians (APCs) in a distinct clinical area. The Lead ... respective department of hire Clinical Oversight and Leadership:Provides supervision and management of advanced practice clinicians (APCs) in a distinct clinical… 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 ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- … 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… more
- Elevance Health (Wallingford, CT)
- …locations may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be ... ** Utilization Management Medical Director -...** Utilization Management Medical Director - NC Medicaid** Location:...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical ... enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health...resource utilization under the UCLA Medical Group Utilization Management guidelines. In this role, you… more
- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- BrightSpring Health Services (Sacramento, CA)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- Commonwealth Care Alliance (Boston, MA)
- … Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a ... Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible...for overseeing and managing the daily operation of the Utilization Management Review Nurse and… more
- Elevance Health (Las Vegas, NV)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- Sharp HealthCare (San Diego, CA)
- …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… 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...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… 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 full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Tufts Medicine (Burlington, MA)
- …to the utilization of resources, coordination of care across the continuum and utilization review and management . The position develops and leads the ... leaders, to review metrics and discuss any operational issues. Coordinates Utilization Management meetings and deliverables. 6. Acts as Co-chair System UM… 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 ... Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes,… more
