- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
- Community Health Systems (Carlsbad, NM)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... **Relocation Assistance** available. Day Shift hours. **Job Summary** The Director , Care Management is responsible for overseeing...experience required + 3-5 years of experience in care management or utilization review required + 1-3… more
- Evolent (Santa Fe, NM)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Evolent (Santa Fe, NM)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Santa Fe, NM)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Santa Fe, NM)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Molina Healthcare (Roswell, NM)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Humana (Santa Fe, NM)
- …Medical Director , depending on size of team or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Santa Fe, NM)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- Evolent (Santa Fe, NM)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- United Therapeutics (Santa Fe, NM)
- …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more
- Genesis Healthcare (Santa Fe, NM)
- …with our Clinicians in Action professional development program. Responsibilities The Director of Rehab is responsible for the efficient administrative and ... operational management of rehabilitation services in their assigned account(s). This...in integration of rehabilitation services in all settings. The Director of Rehab ensures that the highest standard of… more
- Humana (Santa Fe, NM)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Evolent (Santa Fe, NM)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Surgery you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- Evolent (Santa Fe, NM)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- Genesis Healthcare (Santa Fe, NM)
- … Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The Medical ... on call)! We are seeking a FFS Attending Physician/Medical Director for split position between our Casa Real Center,...Family Medicine with LTC Experience. AlignMed Partners is a national medical group dedicated to improving health outcomes among… more
- Three Saints Bay (Albuquerque, NM)
- …leader is looking for a **Facility Director to** supervise all facility management work performed under the DOE National Training Center contract. The FD ... **Facility Director (4780)** Location **Albuquerque, NM** Job Code **4780**...is the senior contractor management representative responsible for ensuring all facilities are properly… more
- Evolent (Santa Fe, NM)
- …leadership is preferred. + Familiarity with value-based care models and utilization management frameworks is preferred. **Technical Requirements:** We require ... of our specialty programs and administrative platform. **Role Overview** The Associate Director role on Client Analytics will support both internal teams (EAS,… more
- Renaissance (Albuquerque, NM)
- … management , design, administration, communication, compliance, activities and vendor management . The Director will manage, plan, direct, develop, communicate ... strive for the best, own our actions, and grow and evolve. The Director of Compensation & Benefits is responsible for the strategic direction and leadership… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- **Associate Director , Channel Strategy and Patient Affordability** The Associate Director , Channel Strategy and Patient Affordability reports to the Executive ... Director , Channel Strategy and Patient Affordability. The Associate ...resources effectively across the team to ensure efficient budget utilization , while identifying cost saving opportunities + Design operational… more