- 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
- Commonwealth Care Alliance (Boston, MA)
- …Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… 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 ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Tufts Medicine (Burlington, MA)
- … review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization ... of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… 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 ... The **Medical Director ** will be responsible for utilization review case management for North Carolina...programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor… more
- Commonwealth Care Alliance (Boston, MA)
- …quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management ... Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term… 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 (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management , provides organizational leadership in the operational areas of appeals, utilization ... policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work… more
- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Molina Healthcare (GA)
- …of healthcare services professionals in some or all of the following functions: utilization management , care management , behavioral health and other ... one or more of the following key health care services functions: care management , utilization management , care transitions, long-term supports and services… 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 ... a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We...appropriate utilization of medical services. The Medical Director of Utilization Management serves… more
- CommonSpirit Health (Phoenix, AZ)
- …contribute to high-level organizational decision-making, working closely with other executives and clinical leaders to align utilization management practices ... **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of...Under direction of the System Senior Vice President of Clinical Regulatory and Revenue Enhancement, this role will have… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue...the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on… more
- ERP International (Barksdale AFB, LA)
- …co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and ... **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for...Ensure coordination and communication among all MM staff, including clinical and business personnel, to assure efficient, effective, quality… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and ... reviews, prepayment retrospective reviews, and any additional utilization management functions. + Coordinates with Humana's Clinical Leadership teams… more
- UCLA Health (Los Angeles, CA)
- …or MSN degree + Active CA RN License + Minimum of 2 years' experience in utilization management , Inpatient CM or clinical Experience. + Strong knowledge of ... Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization ...resource utilization under the UCLA Medical Group Utilization Management guidelines. In this role, you… more
- Genesis Healthcare (Ashland, VA)
- …oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification is overseen by a licensed ... therapists, consideration of clinical requirements, and recommendations from the Clinical Director . 10. Administers financial controls of revenue and… more
- Genesis Healthcare (Los Angeles, CA)
- …oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification is overseen. 22. Completes monthly ... of clinical requirements, and recommendations from the Clinical Director . 12. Administers financial controls of...a representative of Powerback Rehabilitation. 21. Ensures that the clinical management of the rehab department, including… more