- Elevance Health (Columbus, OH)
- …Charleston + Maine, South Portland + New Jersey, Morristown **Description** **Clinical Operations Medical Director ** ** Utilization Management of ... part of consideration for employment. ** Medical Oncology Medical Director - Utilization Review**...Medical Oncology team** is responsible for supporting the medical management staff ensuring timely and consistent… more
- CVS Health (Springfield, IL)
- …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… 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 an ... caring community and help us put health first** The Medical Director relies on medical ...managed care experience working with LTSS program population. + Utilization management experience in a medical… 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 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
- 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 an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- LA Care Health Plan (Los Angeles, CA)
- …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… 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 ... Nurse in Maryland. + Current Basic Life Support/CPR Certification at the Medical Professional Level with AED Training. American Heart Association is the preferred… more
- CVS Health (Columbus, OH)
- …urgent cases can be done from your laptop. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a medical director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
- Carle (Urbana, IL)
- …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
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...for medical staff on issues related to utilization management . 1. Implements utilization … more
- Trinity Health (Boise, ID)
- …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and ... and consistent with all PH&S policies and procedures. + Provides expertise in Utilization Management to Nursing and Medical Staff; Is viewed as a resource… more
- Regis HR Group (Miami, FL)
- …trains and disciplines staff to ensure smooth operations in utilization management . + Also facilitates educational training for medical staff on issues ... Develops, manages and directs the Utilization Management programs for the primary... trends, patterns, and impact to appropriate departmental and medical staff committees. + Assures compliance with Federal, State,… 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 ... inpatient alcohol detox and outpatient chemical dependency services. Position Summary: The Clinical Director of Utilization Management is responsible for the… more
- Prime Healthcare (Ontario, CA)
- …https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Corporate Director of Clinical Utilization ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/154484/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… 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...Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell… more
- Molina Healthcare (Detroit, MI)
- …as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… 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 ... a proud provider of the Patriot Support Program. The Director of Admissions/ Utilization Management is...Competitive Compensation and Generous Paid Time Off + Excellent Medical , Dental, Vision and Prescription Drug Plans + 401(k)… more
- Universal Health Services (Harahan, LA)
- … UTILIZATION REVIEW DIRECTOR to direct and serve within the Utilization Management team. Evaluates patient medical records to determine severity ... with a psychiatric mental health population desired. 2-3 years experience in Utilization Review. Management experience preferred. + Education: Bachelors prepared… more
- Universal Health Services (Memphis, TN)
- …psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health ... diagnosis and the ability to articulate those indicators professionally. The UR Director evaluates patient medical records to determine severity of patient's… more