- BroadPath Healthcare Solutions (Tucson, AZ)
- …staff on managed care and Medicaid policies and procedures D. Conducts staff and medical director audits on appeal activities + Assists with appeal file ... **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical … more
- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. - Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...- Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …and present authorization requests with supporting documentation for review with the Medical Director . + Assume responsibility for ensuring timely reviews of ... of medical standards of practice or experience with using UM medical criteria (ie Milliman and InterQual) required. + Strong Computer experience including… more
- HealthCare Support (Houston, TX)
- …approved medical guidelines. Refers cases that do not meet criteria to Medical Director for review. 2. Assists in discharge planning especially Home Health ... services and if not meeting criteria, refer to the Medical Director . 3. Participates in Community Nursing...required information into the managed care platform, adhering to UM policies and procedures. 5. Assists in the coordination… 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
- COLLIN COUNTY MENTAL HEALTH RETARDATION CENTER (Mckinney, TX)
- …Description The Access and Diversion Program Administrator reports directly to the Director of Crisis Servies and is responsible for management and oversight of ... obtained within 6 months of hire. *Knowledge of Texas Administrative Codes and UM Guidelines related to Community Mental Health Centers, required. *Two (2) years of… more
- CVS Health (Springfield, IL)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- CVS Health (Trenton, NJ)
- …primarily supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members ... in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- Humana (Lincoln, NE)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- Elevance Health (Chicago, IL)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefit Management** **Genetic Testing Utilization Management/Review** **Virtual:** This ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical… more
- Dignity Health (Bakersfield, CA)
- …across the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management ( UM ) and the Medical ... as providing clinical leadership and guidance to other physician medical directors within the UM department, ensuring...and Clinical Oversight functions. + Oversee and manage the medical director capacity to support Managed Care… more
- CVS Health (Hartford, CT)
- …candidates can live anywhere in the contiguous United States. **Position Summary** The Lead Director of UM Innovation Delivery is a critical leader and has ... and objectives. + Drive transformation initiatives to modernize healthcare UM operations by aligning cross-functional teams (business, IT, architecture, operations)… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- CVS Health (Springfield, IL)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… 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...+ Achieves and maintains benchmarked utilization and cost management ( UM ) goals and clinical quality improvement (QI) objectives, in… more
- 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
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- Elevance Health (Miami, FL)
- ** Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida...criteria (eg, MCG, InterQual, CMS guidelines). + Collaborate with UM nurses and case managers to review inpatient admissions,… more
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