- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and ... focus on Utilization Management and Denials principles such as performance improvement, healthcare finance (including contractual arrangements, utilization… more
- Elevance Health (San Francisco, CA)
- …you a check, or ask you for payment as part of consideration for employment. **Solutions Management Director - Utilization Management ** + Job Family: BSP ... CA, SAN FRANCISCO + NJ, ISELIN + VA, NORFOLK **Description** **Solutions Management Director - Utilization Management ** **Location:** This position will… more
- Universal Health Services (Sacramento, CA)
- Responsibilities Sierra Vista Hospital is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare ... detox and outpatient chemical dependency services. Position Summary: The Clinical Director of Utilization Management is responsible for the development of… more
- Prime Healthcare (Ontario, CA)
- …Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities TheCorporate Director of Clinical ... Utilization Management (UM)provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to the EPO… more
- Ascension Health (Austin, TX)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and claims processing. + Oversee work with provider relations on resolving issues. + Manage… more
- Elevance Health (Columbus, OH)
- …South Portland + New Jersey, Morristown **Description** **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** ... you for payment as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review** + Job Family: MED > Licensed… more
- Universal Health Services (Bradenton, FL)
- Responsibilities Palm Shores Behavioral Health is currently seeking a Director of Admissions and Utilization Management Palm Shores Behavioral Health Center ... We are a proud provider of the Patriot Support Program. The Director of Admissions/ Utilization Management is responsible for the patient intake process;… more
- Universal Health Services (San Antonio, TX)
- …Standards, providing on-site education to manage difficult cases, and assisting the Director of Utilization Management with department processes and ... procedures. Key Responsibilities: + Maintains knowledge of all facets of Utilization Management + Supports Director and performs management duties when … more
- Universal Health Services (Colorado Springs, CO)
- … Management Care Coordinator opportunity available, this position reports to the Director of Utilization Management . Schedules vary. About the Position: ... (attached) with a current resume and turn it in to Susan Chambers, Director of Utilization Management , Human Resources or the reception desk on the first… more
- Carle (Urbana, IL)
- …of multidisciplinary team members and the medical staff. + Collaborates with the System Director Utilization Management and Clinical Denial Management . + ... Director - Regional Care Management East/South...of care + Effectively reduces hospital readmissions and inappropriate utilization of hospital resources. + Provides regular updates to… more
- Universal Health Services (Memphis, TN)
- …Come join our team and love what you do! We are currently hiring a full time Director of Utilization Management (UM) for Compass Intervention Center! The UM ... medical staff, management team and all other departments. The UM Director performs other duties as assigned. Compass Intervention Center is a fully accredited,… more
- Universal Health Services (Jacksonville, FL)
- Responsibilities Wekiva Springs Center of Jacksonville is seeking an experienced Director of Utilization Management . Wekiva offers:* Premium salary ... 401 K with up to 4% match* Tuition reimbursement* Generous PTO The Director of Utilization management is responsible for directing and overseeing the … more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- CVS Health (Springfield, IL)
- …to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and ... Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Indianapolis, IN)
- … 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....time to the Indiana Pathways program to assist the Utilization Management , Care Management , and… more
- Humana (Columbus, OH)
- … 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 (Columbus, OH)
- … 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 (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director , the Supervisor of Utilization Management is responsible ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more