- 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
- Houston Behavioral Healthcare Hospital (Houston, TX)
- … 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… 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
- 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
- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- BrightSpring Health Services (Sacramento, CA)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… 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 ... Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible...for overseeing and managing the daily operation of the Utilization Management Review Nurse and… more
- MyFlorida (West Palm Beach, FL)
- OPERATIONS & MGMT CONSULTANT MGR - SES - 60074713 Date: Sep 23, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 861567 Agency: Children and Families Working Title: OPERATIONS & MGMT CONSULTANT MGR - SES - 60074713 Pay Plan: SES Position Number: 60074713… more
- Elevance Health (Las Vegas, NV)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- Sharp HealthCare (San Diego, CA)
- …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… 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
- Elevance Health (Louisville, KY)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... **Medical Management Nurse** **Location:** This role enables associates to...is medically necessary and provides consultation to the Medical Director on cases that are unclear or do not… 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
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