- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… 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
- AmeriHealth Caritas (Newtown Square, PA)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership ... policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... 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
- Humana (Pierre, SD)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice for… more
- Intermountain Health (Las Vegas, NV)
- … management , claims, network management , and finance. As the Medical Director for Utilization Management , you are responsible, in partnership with ... timely documentation and reporting. + Demonstrated knowledge of case management , utilization management , quality management , discharge planning,… 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 ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
- Commonwealth Care Alliance (Boston, MA)
- …of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- HonorHealth (AZ)
- …hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management , Nursing, the Chief Medical Officer and ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for departmental assessment,… more
- The Cigna Group (Bloomfield, CT)
- **Overall** Responsible for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate ... contracting efforts to ensure alignment across formulary, utilization management , SafeGuard, and other trend solutions. **Essential Functions:** + Ability to… more
- Gentiva (Mooresville, NC)
- … Manager** to join our team. This position will directly report to the Director of Utilization Management and is responsible for planning, coordinating, ... related to PPD vendors: medical supplies, durable medical equipment, and pharmacy utilization . + Works closely with branch leadership to identify and deploy… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... **Job Description** The Assistant Director of Case Management supports the... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- Prime Healthcare (Inglewood, CA)
- …credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/ director -of-case- management utilization - management ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case...Nurse will route the case to the UR Medical Director . The UR Medical Director will review… 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 ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management , Care Management , Medicare… more
- Humana (Dover, DE)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). This is a remote based, work...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Humana (Charleston, WV)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Concord, NH)
- …Medical Director , depending on size of team or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on...with prior experience participating in teams focusing on quality management , utilization management , case … more
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