- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Director of Utilization Review is responsible for overseeing all utilization review activities to ensure that clients ... for each client. This individual leads a team of utilization review specialists and works closely with...medical necessity for all levels of care provided. The Director also supports and maintains strong collaboration with facility… more
- Tenet Healthcare (Detroit, MI)
- Group Utilization Review Director - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions necessary to support… more
- Ascension Health (Nashville, TN)
- …Direct services, workflow and resources for assigned nursing travelers. + Develop departmental goals and objectives consistent with medical, administrative, legal and ... ethical requirements of the health care delivery system. + Direct clinical activities, including patient assessment, care plan development, service level determination, patient visits, and complaint management. + Prepare and monitor budget(s) and ensure that… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership with MG Clinical… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- UTMB Health (Friendswood, TX)
- …trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review /Case Management. + Maintains a documentation ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,… 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
- Humana (Louisville, KY)
- …of our caring community and help us put health first** The Associate Director , Utilization Management utilizes clinical nursing skills to support the ... of medical services and/or benefit administration determinations. The Associate Director , Utilization Management Nursing requires a solid understanding… more
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... **Job Description** The Assistant Director of Case Management supports the Director...the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Assistant… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll lead… 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
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of-case-management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital… more
- Wellpath (Lemoyne, PA)
- …Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and practice ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Intermountain Health (Murray, UT)
- …responsible for the development, implementation, evaluation, and operational management of utilization review programs to include prior authorization, acute and ... healthcare journey. + Oversees program components related to care management and utilization review for the specific line of business, across all service areas… more
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Insight Global (Boston, MA)
- Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... fall within the Clinical Performance, Operations, and Innovation organization. The Director is responsible for providing strategic guidance to the business, ensuring… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... functions for assigned sites. + Collaborate with the director to develop and implement quality review ...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
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