- Elevance Health (Louisville, KY)
- …must live within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- Elevance Health (Atlanta, GA)
- …within 50 miles of one of our Elevance Health office locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- Elevance Health (Rancho Cordova, CA)
- …disability plans, and are flexible enough to fit any size business. The ** Medical Director ** is responsible for the administration of physical and/or behavioral ... Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency. Preferred Skills,… more
- Robert Half Office Team (Los Angeles, CA)
- …staff, physicians, providers, members/family to get a successful discharge plan * Collaborate with the UM Director and Medical Director for case reviews ... Description We are seeking a UM Review Nurse to ensure the quality and...Review Nurse to ensure the quality and cost-efficiency of medical care by applying clinical knowledge and implementing policies… more
- City and County of San Francisco (San Francisco, CA)
- …specifically in the Mental Health Service Center + Supervises medical staff, including UM Medical Director , OCC Nurse Practitioner, and the medical ... health services, including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective leadership and… more
- Nuvance Health (Norwalk, CT)
- …cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. ... Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary… more
- Sharp HealthCare (San Diego, CA)
- …to the processing of the referral.Consults with supervisor, team lead and/or medical director to discuss requests/care inconsistent to criteria and determine ... requirements for the position, and employer business practices. **What You Will Do** The UM Resource Coord-SCMG serves as a resource to the various teams in the SCMG… 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 (Lansing, MI)
- …Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Required Qualifications + Must ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- Robert Half Office Team (Monterey Park, CA)
- …member/family interaction to develop and implement a successful discharge plan * Works with the UM Director and Medical Director on case reviews for ... Management Nurse Specialist LVN promotes the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies… more
- UCLA Health (Los Angeles, CA)
- …state and federal laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with ... MSO, IPA, or health plan) + In-depth knowledge of medical terminology + Understanding of the HMO referral process,...records + Ability to thrive within a complex academic medical center + Ability to develop, implement, and evaluate… more
- Healthfirst (NY)
- …and medical departments Conduct ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. Collaborate with ... Duties/Responsibilities: Support the Medical Policy and Clinical Utilization Management ( UM...the Medical Policy and Clinical Utilization Management ( UM ) Governance Committee Chairs, committee members, and related workgroups… more
- CVS Health (Springfield, IL)
- …clinical support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management ( UM ) functions for physical health ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300...more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- CVS Health (Boston, MA)
- …Massachusetts market - hospitals, outpatient networks, and value-based care relationships. The Medical Director will be required to have a Massachusetts state ... to obtain the license within a reasonable timeframe. The Medical Director will be responsible for Account...of the states in the New England Region Previous UM experience with a Health Plan / Payor. Previous… more
- Magellan Health Services (Albuquerque, NM)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- Baylor Scott & White Health (Temple, TX)
- …plan and network managed care performance. + Partner with Provider Networks and Medical Director team in creating and maintaining programs that incentivize ... to interface with providers, staff, and management. + Knowledge of medical , quality improvement and UM practices in a managed care environment. + knowledge of… more
- YesCare Corp (Hagerstown, MD)
- …disabled Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality ... is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare located in...safety and chart and site audits. + Adherence to UM programs specific to the contract requirements and corporate's… more
- CVS Health (Atlanta, GA)
- …license without encumbrances in one (1) of those five (5) states. + In the Medical Director role you will provide oversight for medical policy ... consistent responses to members and providers. + As a Medical Director you will focus primarily on...States Market (Georgia, Louisiana, Alabama, Mississippi, or Arkansas). Previous UM experience with a Health Plan / Payor. Previous… more