- AmeriHealth Caritas (Newtown Square, PA)
- …administrative services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, … more
- Rady Children's Hospital San Diego (San Diego, CA)
- …team of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with ... benefits with a remote work option. JOB SUMMARY: The Medical Director , UM is a clinical subject-matter...knowledge of health plan operations, clinical issues, trends and medical management , utilization management… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director ...Utilization Management programs at AnMed. The Medical Director ensures the program and associated ... the leadership and staff who perform the functions of Utilization Management (UM), Case Management ...practice preferred. + Minimum of five years post residency medical practice experience with hospital, managed care or long-… more
- Intermountain Health (Las Vegas, NV)
- …, care management , claims, network management , and finance. As the Medical Director for Utilization Management , you are responsible, in ... quality improvement efforts. Serves as the chair of Quality Medical Management Committee (QMMC) and other designated...timely documentation and reporting. + Demonstrated knowledge of case management , utilization management , quality … more
- Wellpath (Lemoyne, PA)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
- Humana (Honolulu, HI)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Dover, DE)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Springfield, IL)
- …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...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Humana (Providence, RI)
- …Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...Medical Hematology/Oncology specialties + Prefer Medicaid experience + Utilization management experience in a medical… more
- Humana (Madison, WI)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Springfield, IL)
- …a regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... the Enterprise. The individual works in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders...and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...data received from external agencies, Physician Advisors and the Medical Director . 10. Works collaboratively with Admitting,… more
- Ascension Health (Nashville, TN)
- …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, ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...optimize patient care and partner with the National Senior Director of UM to align on organizational goals. Ready… more
- Prime Healthcare (Inglewood, CA)
- …director -of-case- management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens… more
- Tenet Healthcare (Detroit, MI)
- …and safe and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials prevention. ... Group Director Utilization Review - 2506000536 Description... Management Monitors the review process to ensure medical necessity patients to be in the appropriate status… more
- Intermountain Health (Murray, UT)
- …service lines of business(s). The position requires an understanding of utilization management industry benchmarks, best practices and regulatory environment ... and refinement of tools, processes and systems to optimize medical management , clinical outcomes and member satisfaction...impact trends. + Uses a data-driven approach to assess utilization management and care management … 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 ... federal, state, and local regulatory guidelines. -Support the development of utilization management policy initiatives. -Support the development and… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim ... responsibility for the entire scope of Care Coordination for MercyOne Medical Center and MercyOne West Des Moines. Operational responsibilities include budgeting,… more