- Regal Medical Group, Inc. (Northridge, CA)
- …for effective patient centered utilization management; together with the medical director , interprets and administers pertinent laws; through direct and ... UM compliance staff to promote quality, cost effectiveness medical care through strict adherence to all UM... coordinates, plans and manages staff activities; develops with Medical Director program goals and objectives; makes… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and to pivot from a "job" opportunity to an authentic experience! The Medical Director of Behavioral Health is responsible for clinical oversight, clinical ... but are not limited to, case management, quality management, utilization management ( UM ), and grievance and appeals...), and grievance and appeals and committee participation. The Medical Director of Behavioral Health oversees the… more
- Liberty Health (Wilmington, NC)
- …on fax and authorization queues, and other documents incoming and outgoing. Assist Utilization Management RNs and Director with projects as needed. Attend and ... to all internal Utilization Management meetings Ability to be an interactive UM team member to ensure compliant execution of UM program Review admissions… more
- Regal Medical Group, Inc. (San Bernardino, CA)
- …If not indicated, they will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the ... is picked up when needed. When appropriate, coordinate and review for medical necessity and appropriate utilization any ancillary professional services, ie… more
- Dignity Health (Rancho Cordova, CA)
- …review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from ... home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director the Supervisor of Utilization Management is responsible and… more
- Actalent (Redlands, CA)
- Job Title: UM CoordinatorJob Description The Utilization Management ( UM ) Coordinator is responsible for executing all aspects of the referral process. The ... based on clinical protocols. This role involves effective communication and interaction with utilization review nurses and health plans regarding UM and referral… more
- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... for accessibility within the network. - Consults with the medical director on cases that do not...information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. -… more
- CVS Health (Springfield, IL)
- …that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...region. Key Responsibilities + Leadership & Management**: + Oversee Utilization Management ( UM ) across assigned hospitals, ensuring… more
- Commonwealth Care Alliance (Boston, MA)
- 023520 Clin Alli-Physicians Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the ... Utilization Review Medical Director will be responsible for providing leadership and subject...for providing leadership and subject matter expertise to our utilization management ( UM ) group. This role is… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... patient care and the appropriate utilization of medical services. The Medical Director ...admissions. + Evaluate and recommend policy improvement related to utilization reviewsystem, andprovide UM updates and participate… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the...critical to the success of our members and the Utilization Management ( UM ) department in realizing its… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the...Management Nurse will route the case to the UR Medical Director . The UR Medical … more
- LA Care Health Plan (Los Angeles, CA)
- …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- Guthrie (Troy, PA)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management ( UM ) Reviewer, in collaboration with...time frames. Knowledge of health benefit plans and related UM requirements preferred. Experience with CPT/ICD coding, medical… more
- Beth Israel Lahey Health (Burlington, MA)
- …patients admitted to the Clinic Attending Physicians: Coordinates appropriate documentation Medical Director for /Managed Care, Physician Advisors Works ... taking a job, you're making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for… more
- AdventHealth (Glendale Heights, IL)
- …which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. Qualifications **The expertise and ... 60139 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is...physician advisor to avoid concurrent denials. + Collaborates with medical staff, nursing staff, payor, and ancillary staff to… more
- LA Care Health Plan (Los Angeles, CA)
- …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... Utilization Management Nurse Specialist RN II Job Category:...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group… more
