- Tenethealth (San Antonio, TX)
- This position may qualify for a sign-on bonus POSITION SUMMARY The Director is responsible for planning, organizing, directing and managing resources for one to two ... hour basis. These responsibilities include: budget responsibility; efficient/effective resource utilization ; recruitment and effective/efficient management of assigned staff; achieving… more
- 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
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management, provides organizational leadership in the operational areas of appeals, utilization review, ... and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work… 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
- 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
- Elevance Health (Wallingford, CT)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... not required. Alternate locations may be considered. The **Medical Director ** will be responsible for utilization review...The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May… 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** **New** Nursing & Care Management UTMB Health… more
- Centene Corporation (Tallahassee, FL)
- …Doctor of Osteopathy, Indiana-licensed Geriatrician that assists the Chief Medical Director , Utilization Management, Care Management, and Quality departments' ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement… more
- Monte Nido (Miami, FL)
- …peer to peer reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management. + Maintain database of insurance company ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… 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
- Corewell Health (Grand Rapids, MI)
- …in coordination with external partners and reports directly to the Senior Director of Utilization Management. Essential Functions Strategic Leadership & Program ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...Develop and implement operational plans to improve LTSS access, utilization , and quality. + Lead initiatives to align LTSS… 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
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