- Intermountain Health (Las Vegas, NV)
- …utilization management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, ... 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review ,… 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 with and provide consultation to the… 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 ... and most diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions necessary to… more
- Trinity Health (Des Moines, IA)
- …**Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join Trinity Health 's ... for the entire scope of Care Coordination for MercyOne Medical Center and MercyOne West Des Moines. Operational responsibilities...previous experience in large, complex care coordination at a director level or equivalent. + 3 years previous acute… 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
- 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
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management 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… 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 ... from external agencies, Physician Advisors and the Medical Director . 10. Works collaboratively with Admitting, Transfer Services and Finance to ensure… more
- Prime Healthcare (Inglewood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of-case-management utilization ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization … 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 ... in the TN market. We're looking for an experienced Director of Utilization Management to join our...consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities. Ascension is a… 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 ... 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 ... and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order...+ Oversees program components related to care management and utilization review for the specific line of… more
- Ascension Health (Nashville, TN)
- …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 assigned nursing area operates within allocated… 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 ... within the Clinical Performance, Operations, and Innovation organization. The Director is responsible for providing strategic guidance to the...will start on day one of employment and include medical , dental, and vision insurance, as well as HSA,… 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 ... improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… 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** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- AmeriHealth Caritas (Dover, DE)
- …compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Ascension Health (Baltimore, MD)
- … review programs and key performance indicators for all utilization review activities. + Interact with medical , nursing, and executive leadership to ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… 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… more
- Amity Foundation (Tucson, AZ)
- …generated by association with substance abuse students. Title: Utilization Review Specialist Reports To: Dragonfly Program Director Job Number: Department: ... building. Remembrance, Resolution, Reconciliation, Restoration, Renewal Job Summary: As the Utilization Review Specialist, you will contribute to the… more
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