- CenterWell (Boston, MA)
- …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical ... Director , Primary Care work assignments involve moderately complex to...requires an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims.… more
- Humana (Little Rock, AR)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Pierre, SD)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... weekend with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more
- Centene Corporation (Jefferson City, MO)
- …Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead a ... team of medical directors and supervises MD's responsible for utilization management and appeals functions to ensure members receive medically necessary, evidence-based care aligned with bet practice promoting safety, quality and cost of care outcomes. Assist… more
- CVS Health (Springfield, IL)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals)… more
- Integra Partners (Troy, MI)
- …Strategic and Operational Leadership + Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams to drive ... clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM team. + Ensure consistent, accurate, and compliant application of… more
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… more
- Integra Partners (Troy, MI)
- …call center and other internal & external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly to change ... The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director ) with administrative and non-clinical tasks related to processing… 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 (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Fischell Department of Bioengineering, and Maryland Institute for Neuroscience Discovery ( UM -MIND). The Director is expected to contribute 10-15% effort ... * Director of Basic and Translational Research* (Ph.D. and/or...and elevate the visibility of the department's research portfolio. UM -Neurosurgery seeks to solve complex neurological problems to improve… more
- CommonSpirit Health (Salt Lake City, UT)
- …for maintaining a collaborative partnership with the Medical Director CDI, Enterprise Director Case Management, UM Hub Director , and Care Coordination ... position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination teams to ensure correct patient status,… more
- University of Michigan (Ann Arbor, MI)
- Chief Supply Chain Officer, UM Health Apply Now **Job Summary** **Basic Function and Responsibilities** The Chief Supply Chain Officer (CSCO) is an executive-level ... of Michigan Health, responsible for the 'end-to-end' supply chain management for UM Health, including the University of Michigan Health Academic Medical Center (AMC)… more
- Point32Health (MA)
- …+ Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Director **Salary Range** $107,921.67 -$161,882.51 **Compensation & ... . **Job Summary** Under the direction of the Pharmacy Utilization Management ( UM ) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... improving the quality of life and longevity of the citizens of Maryland. The UM -IHC, located in North Bethesda, MD, is a collaborative effort of the University of… more
- Elevance Health (Richmond, VA)
- …May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare service ... providers and internal and external customers to help improve health outcomes for members. + Refers complex or unclear reviews to higher level nurses and/or Medical Directors. + Educates members about plan benefits and physicians. Does not issue medical… more
- Dignity Health (Bakersfield, CA)
- …the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management ( UM ) and the Medical Director of ... clinical leadership and guidance to other physician medical directors within the UM department, ensuring the realization of the clinical vision and strategic… more
- University of Miami (Miami, FL)
- …overall success. + Serves as a liaison between the Program Director (s), administrative leadership, UM /JMH Graduate Medical Education (GME) administration, ... fellowship program(s). The GME Program Administrator (A) supports the program director (s) and residents/fellows by ensuring all administrative tasks are performed to… more
- AmeriHealth Caritas (LA)
- …to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible to ensure ... perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification.… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Data/Adaptive Clinical Trials*at the University of Maryland-Institute for Health Computing ( UM -IHC) and*Assistant Director for Learning Health System and ... and innovation to win extramural funding and new public-private partnerships involving UM -IHC, respectively. UMGCCC: The role of*Assistant Director for Learning… more
- University of Michigan (Dearborn, MI)
- …The Assistant Director of Alumni Engagement provides leadership for increasing UM -Dearborn's ability to engage alumni in the life of the university. This ... Assistant Director of Alumni Engagement Apply Now **How to...outreach, and improve the connection our alumni have with UM -Dearborn. The successful candidate will develop and execute programs… more