- Novo Nordisk Inc. (Plainsboro, NJ)
- …any time throughout the annual performance cycle. Relationships Reports to Executive Director or Vice President Medical Affairs. Has direct supervisory ... About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk...resources, supporting appropriate use of NNI products and greater utilization of its services Takes a leadership role in… more
- Eisai, Inc (Nutley, NJ)
- …difference. If this is your profile, we want to hear from you. The Associate Director (AD), Global Medical Affairs Training and Education is responsible for the ... for internal medical training content. Train new hires on EMAC organization/ utilization .Provide input into and collaborate with regional and global medical … more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …customers. Relationships This position reports into a Vice President or Sr. Director within the National Account Market Access Teams. Internally, this position has ... (Pricing, Contracting, Operations and Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance. External relationships include… more
- Novo Nordisk Inc. (Boston, MA)
- …the business potential o the territory. Relationships Reports to the Regional Director - Rare Endocrine. External relationships include those with the following: ... and Professional Associations. Internally, this position will collaborate with STARS Medical Liaisons, and STARS Account Managers. Essential Functions Attention to… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership ... Serve as the lead for CCA's Utilization Review functions working closely with other medical ...preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer… more
- Elevance Health (Dearborn, MI)
- …time zone hours.** The ** Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... ** Medical Director - Commercial** Location: This role...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... optimal patient level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the Director for … 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 ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- AdventHealth (Glendale Heights, IL)
- …resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...physician advisor to avoid concurrent denials. + Collaborates with medical staff, nursing staff, payor, and ancillary staff to… more
- AmeriHealth Caritas (LA)
- …compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- AmeriHealth Caritas (Washington, DC)
- …compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and… more
- US Tech Solutions (Columbia, SC)
- … review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of care ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years… more
