- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- Dignity Health (Rancho Cordova, CA)
- …review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from ... home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director the Supervisor of Utilization Management is responsible and… more
- CVS Health (Springfield, IL)
- …that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... patient care and the appropriate utilization of medical services. The Medical Director ...admissions. + Evaluate and recommend policy improvement related to utilization reviewsystem, andprovide UM updates and participate… more
- Tenet Healthcare (Detroit, MI)
- Group Director Utilization Review - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... most diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions necessary to support… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the...critical to the success of our members and the Utilization Management ( UM ) department in realizing its… 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 partnership with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines...be engaged in these important projects along with traditional UM activities: Member of the Medical Leadership… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively...the leadership and staff who perform the functions of Utilization Management ( UM ), Case Management (CM), Transition… more
- Ascension Health (Nashville, TN)
- …market. Must 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 ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...optimize patient care and partner with the National Senior Director of UM to align on organizational… more
- The Cigna Group (Bloomfield, CT)
- …for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate contracting efforts to ensure ... alignment across formulary, utilization management, SafeGuard, and other trend solutions. **Essential Functions:**...+ Ability to manage development and execution of clinical UM strategy. This would include both the ongoing updates… more
- LA Care Health Plan (Los Angeles, CA)
- …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … 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...stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require… 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 ... taking a job, you're making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for… 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 ... decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization… more
- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... for accessibility within the network. - Consults with the medical director on cases that do not...information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. -… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
- Ochsner Health (New Orleans, LA)
- …and comply with Federal and State regulations/quality initiatives. Reports to the System Medical Director of Utilization . This job description is a ... Utilization Management experience (preferred) + Familiarity with: Current medical literature, Healthcare reimbursement issues (eg, medical necessity, levels… more
- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... services. Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration with an interdisciplinary… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for...as a RN, preferably in a hospital setting + Utilization management experience in a health plan UM… more
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