- 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
- 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)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care… more
- Geisinger (Scranton, PA)
- …Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of ... provide effective and meaningful educational programs across the department. Responsible for management of the Utilization Review policy and observation … 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)
- **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Regis HR Group (Miami, FL)
- Develops, manages and directs the Utilization Management programs for the primary care clinics. The key objective is to drive cost-effective, high-quality care ... Medicare Part A, B and D. Takes data driven approach when formulating utilization management solutions. + Creates, manages and updates preferred specialist… 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 (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 (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....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 ... 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
- AmeriHealth Caritas (Dublin, OH)
- …Behavioral Health Medical Director + Population Health Director + Integrated Care Management Director + Utilization Management Liaison + Quality ... and strategic direction of clinical, quality, and population health programs across care management , utilization management , quality, and value based care +… more
- YesCare Corp (Hanover, MD)
- …Shares information gathered at the quarterly area multidisciplinary CQI Committee meetings with the Utilization Management Medical Director to be used at the ... setting. + At least 2 years of clinical operations management experience required preferably within a correctional health setting....is a list of your responsibilities as a **Statewide Director of Nursing** with YesCare: + Participates in the… more