- Harbor Health Services, Inc. (Mattapan, MA)
- …We are currently seeking a Director of Utilization Management & Quality Programs . Harbor Health offers an excellent, comprehensive benefits package including ... Programs of All-Inclusive Care for the Elderly, a program that allows frail elders to live in their...Operations, the Director of Utilization Management and Quality Programs is responsible for the day-to-day… more
- Alameda Health System (Oakland, CA)
- …time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, ... as needed. In essence, they orchestrate efficient utilization management to deliver high- quality patient care. DUTIES & ESSENTIAL JOB FUNCTIONS : NOTE: Following are… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review ... + Provide medical expertise in the operation of approved quality improvement and utilization management programs in...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- CenterWell (Annapolis, MD)
- …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical ... Director , Primary Care work assignments involve moderately complex to...ABQAURP, or other boarddemonstratingadvanced training in transitions of care, quality assurance,utilizationmanagementand care coordination. + A current and unrestricted… more
- Elevance Health (Richmond, VA)
- …May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare service ... leadership in enhancing training and orientation materials. + May complete quality audits and assist management with developing associated corrective action plans.… more
- Sharp HealthCare (San Diego, CA)
- …discharge or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, ... SRS primary care physician, and ancillary staff to ensure cost effective quality service throughout the continuum of care. **Required Qualifications** + Other :… more
- Integra Partners (Troy, MI)
- …Experience as a health plan medical director + Experience with DMEPOS UM programs , MLTC, Medicaid, or Medicare Advantage + Experience chairing or ... Strategic and Operational Leadership + Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams to drive… more
- Integra Partners (Troy, MI)
- …inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program . + Serve as a clinical resource for UM ... The Utilization Review Medical Director is responsible for conducting clinical reviews of...(DME) and related requests to support Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a… more
- UNC Health Care (Morrisville, NC)
- …that includes key statistics that impact the success of the organization and the UM program . 2. **Leading People** - Operational oversight of centralized and ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a...compliance with healthcare regulations, measure the effectiveness of the UM program including length of stay (LOS),… more
- CVS Health (Springfield, IL)
- …inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (ie, ... provides clinical oversight and mentorship for CVS Health clinical programs , PBM Clinical Quality activities, consultative support... director will become sufficiently skilled in various UM programs to support other segments (including… more
- Fallon Health (Worcester, MA)
- …we strive to be the leading provider of government-sponsored health insurance programs -including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for ... Description and annually evaluate the effectiveness of the program . + Represents the UM Department in...related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM … more
- University of Michigan (Ann Arbor, MI)
- …UMH-West, and Oakland County + Work in partnership with Head Orthopedic Team Physician for UM Athletics and Medical Director for UM Athletics to assure ... Associate Director , Sports Medicine Apply Now **How to Apply**...your information. **Job Summary** Leadership of Sports Medicine at UM Health will be vested in a multi-disciplinary triad… more
- Wellpath (Lemoyne, PA)
- …UM updates and participate in meetings. + Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and ... * Tuition Assistance and dependent Scholarships * Employee Assistance Program (EAP) including free counseling and health coaching *...is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and… more
- Healthfirst (NY)
- …identify areas for improvement** + **Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program , sometimes through the ... requirements** + **Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner** +...subject matter expert on business development efforts related to UM programs , including the launch of new… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... email address. **Job:** **Faculty* **Organization:** **School of Medicine - Centers/ Programs /ORCs* **Title:** *Physician-Scientist, Director Of Clinical Trial… more
- Humana (Indianapolis, IN)
- …behavioral and physical health services, including Utilization Management ( UM ), Quality Improvement, and value-based payment programs . The Chief Psychiatrist ... Oversees, monitors, and assists with effective implementation of the Quality Management (QM) program ; and work closely...program ; and work closely with the Utilization Management ( UM ) of services and associated appeals related to adults… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- University of Michigan (Ann Arbor, MI)
- Director (Cell and Gene Therapy Program ) Apply Now **Job Summary** The Director of the Cell and Gene Therapy Program holds enterprise-wide accountability ... in planning, organizing, and managing multidisciplinary workgroups to deliver innovative, high- quality care. At the enterprise level, the Director drives… more
- CVS Health (Tallahassee, FL)
- …as needed. * Develop and guide the implementation of Medical Management programs to ensure providers deliver appropriate, high- quality , cost-effective Health ... DSNP/FIDE populations, including the development and implementation of clinical initiatives and programs to address the needs of the populations managed to improve… more
