- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Centene Corporation (Dover, DE)
- …Services and Supports (LTSS) and Medicare-Medicaid Duals populations. Additionally, the Medical Director will collaborate with other key stakeholders to ... medical expertise in the operation of utilization management ( UM ) programs and quality improvement initiatives to ensure compliance...LTSS Only:** A full-time Long Term Services and Supports Medical Officer/ Medical Director (LTSS CMO)… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Intermountain Health (Las Vegas, NV)
- …utilization management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in ... claims, and claims knowledge and experience including demonstrated experience managing claims and claims appeals levels 1-3 are a...be engaged in these important projects along with traditional UM activities: Member of the Medical Leadership… more
- University of Maryland, Baltimore (Baltimore, MD)
- …52 start-up companies*.* In the latest /US News & World Report/ ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked *#9* ... Division of General Obstetrics and Gynecology is seeking a Generalist Division Director who will lead the clinical, administrative, educational, and research goals… more
- CVS Health (Boston, MA)
- …with a strong background in the PBM industry to join our team as the Lead Director , Financial Change Order Connected Ecosystem. In this role, you will lead a team of ... rebate guarantee adjustment process to capture client-initiated plan design, formulary and/or UM changes that could impact our ability to meet previously agreed upon… more
- Catholic Health Services (Melville, NY)
- …the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health ... Physician Advisor meeting. 3. Training and Education Responsible for hiring and managing Physician Advisors, along with developing and monitoring compliance with an… more
- Catholic Health Initiatives (Houston, TX)
- …to maintain effective team leadership and oversight. This role supports the UM Director in ensuring efficient operations with all processes, policies, ... **Responsibilities** The Utilization Management ( UM ) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective… more
- Commonwealth Care Alliance (Boston, MA)
- …with all regulatory, contract and NCQA requirements. + Together with the Director of UM and Sr. Medical Director of medical policy, manage the ... The Manager, Medical Policy reports to the Director of UM , and manages the personnel...team directly through specialized exempt and/or non-exempt employees; developingand managing budgets, schedules, and performance for the MP team… more
- University of Miami (Miami, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of Miami/UHealth Medical Training Lab at the Gordon Center is ... currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami,...per year. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more
- Beth Israel Lahey Health (Burlington, MA)
- …patients admitted to the Clinic Attending Physicians: Coordinates appropriate documentation Medical Director for /Managed Care, Physician Advisors Works ... making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for determining appropriate… more
- Houston Methodist (Sugar Land, TX)
- …assurance and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical ... other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, Precertification and… more
- University of Miami (Miami, FL)
- …inquiries. Prepares, maintains, and reports on program effectiveness. Assists with managing program budget by monitoring expenditures. Stays abreast of market trends ... both online and residential, reports directly to the Associate Dean and inaugural director of online MPH, and offers administrative support for the design and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... needed to ensure proper handling of the appeal eg UM team, medical directors, claims, contact center,...a facilitator or moderator /similar + Experience organizing and managing meetings. + Excellent verbal and written communication skills… more
- University of Michigan (Ann Arbor, MI)
- …and completes performance evaluation for nursing with feedback from the senior nursing director , medical faculty, peer groups, and ACU triad. + Creates job ... NURSING SUPERVISOR (Ambulatory Care Services: Medical Specialties) Apply Now **Job Summary** To participate...Michigan Health, Michigan Medicine. To assist the Senior Nursing Director in planning and management of the patient care… more
- Commonwealth Care Alliance (Boston, MA)
- … staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more
- University of Miami (Miami, FL)
- …. The University of Miami/UHealth Gordon Center for Research in Medical Education is currently seeking a full time Manager, Clinical Training ... programs. An employee in this position supports their leader with managing assigned program components, preparing clinical training documentation, and preparing… more
- Independent Health (Buffalo, NY)
- … medical necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) ... standards set by regulatory and accreditation entities. + Refer appropriate cases to the Medical Director for review and work closely with Case Management to… more
- University of Michigan (Ann Arbor, MI)
- …food service operations in the Pavilion hospital. This role is responsible for managing all aspects of food service meal preparation and delivery for patients, ... world and has been the site of many groundbreaking medical and technological advancements since the opening of the...+ Knowledge of the FDA Food Code and experience managing kitchen operations using safe food handling sanitation and… more
- University of Miami (Miami, FL)
- …of tools for evaluating teachers, courses and resource materials; assisting in medical education research; managing and maintaining educational and clinical data ... The University of Miami/UHealth Gordon Center for Research in Medical Education is currently seeking a full time Manager,...year worldwide. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more
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