- Merck & Co. (Rahway, NJ)
- …members and partner groups including formulators, engineers, Quality, Safety, and Facilities management to drive overall success and performance of the area and ... quantities, equipment used, and environmental conditions.Tactical and strategic shift management , including collaboration with indirect staffBatch Adaptability: Quickly adapt… 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 ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Elevance Health (Wallingford, CT)
- …locations may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be ... ** Utilization Management Medical Director -...** Utilization Management Medical Director - NC Medicaid** Location:...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Commonwealth Care Alliance (Boston, MA)
- … Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a ... for overseeing and managing the daily operation of the Utilization Management Review Nurse and...and support personnel. * Act as liaison with medical director , provider relations, case management and quality… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… 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 ... and full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Tufts Medicine (Burlington, MA)
- …to the utilization of resources, coordination of care across the continuum and utilization review and management . The position develops and leads the ... leaders, to review metrics and discuss any operational issues. Coordinates Utilization Management meetings and deliverables. 6. Acts as Co-chair System UM… 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 ... Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes,… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… 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
- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… 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
- Elevance Health (Dearborn, MI)
- …East Coast time zone hours.** The **Medical Director ** will be responsible for utilization review case management for Commercial business in the New ... **Medical Director - Commercial** Location: This role enables associates to...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... use of services. Under the general supervision of the Director and/or Manager/Supervisor of Medical Management , and...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical ... enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health...resource utilization under the UCLA Medical Group Utilization Management guidelines. In this role, you… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv....inappropriate resource utilization to Director /Assistant Director of Utilization Management . + ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ... and experiencedRegistered Nurse Seniorto take on a critical role in our Utilization Review , Performance Improvement, Nursing Education programs. This is an… more
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