- 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 ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees.… 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 ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees.… 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 ... Represents the company to external entities and/or serve on internal and/or external committees. May chair company committees. +...be required by State contracts or regulations if the Medical Director is filing a role required… 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 ... following SCMG documented operational processes.Accurately interpret external criteria and internal operational documents.Ensure medical necessity criteria selected… more
- CVS Health (Springfield, IL)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM...inter-rater review activities and other quality oversight processes for internal Director UM decisions. If… 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
- YesCare Corp (Hagerstown, MD)
- …disabled Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality ... effective care. Below is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare located in **Hagerstown, MD** :… 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... Internal Medicine, Family Medicine, Emergency Medicine or Internal Medicine / Pediatrics Preferred. Education: Medical Doctor… more
- University of Miami (Coral Gables, FL)
- …here (https://www.myworkday.com/umiami/d/task/1422$7248.htmld) to log in to Workday to use the internal application process. To learn how to apply for a faculty ... of Miami has a great opportunity for an Assistant Director , Academic Advising to work at the Coral Gables...and outreach to ensure students are completing Road to UM tasks, Road to UM modules, and… more
- ChenMed (Louisville, KY)
- …for the foundational business unit of our care model - the center. The Senior Medical Director (SMD) will partner with the Center Director /Center Executive ... The SMD is an earned title where the Center Medical Director completes all necessary primary care...conjunction with the transitional care team; hospital, SNF, post-acute, UM , and home-based services for the division. + Assists… more
- CVS Health (Columbus, OH)
- …resistant illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical ... needed* Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community,...Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line… more
- CVS Health (Hartford, CT)
- …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... physical, behavioral and socioeconomic needs.* Partner closely with the Executive Director of Duals and other Duals Care Management leadership to collaborate… more
- University of Miami (Miami, FL)
- …OPO certification to all LAORA staff within 2 years of hire. + Work closely with Medical Director , Director of Operations, and the Executive Director to ... areas of organ donation. + Work closely with the Medical Director , Director of Operations...in an effort to help other members of the medical community learn from the UM OPO… more
- CVS Health (Hartford, CT)
- …personal, convenient and affordable. Job Purpose and Summary: The LTSS/SAI National Senior Medical Director , reporting to a Regional CMO of Medicaid, will ... (SOW)In this role, the selected individual will Partner with internal stakeholders to advocate, promote and champion the vision...LTSS line of business including but not limited to UM , Quality, care management, and network growth as listed… more
- University of Miami (Miami, FL)
- …and coordinates action plans for continuous technology improvement in collaboration with the Medical Director of Technology Innovation and Medical ... support. + Recommends streamlined EPIC workflows and build enhancements in collaboration with Medical Director of Clinic Operations and IT. + Audits, or… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization,… more
- CVS Health (Tallahassee, FL)
- …FL and/or NC license without encumbrances and willing to obtain the other. In the Medical Director role you will provide oversight for medical policy ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...including post-graduate direct patient care experience. Preferred Qualifications: Previous UM experience with a Health Plan / Payor. Board… more