- MetroPlusHealth (New York, NY)
- …the medical necessity of requested healthcare services Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests ... of what you do every day. The Behavioral Health Utilization Management (BH UM ) Clinician is responsible...in containing health care costs and maintains a high-quality medical delivery system through departmental UM procedures… more
- Blue Shield of California (San Diego, CA)
- Job Description Your Role The Behavioral Health (BH) Utilization Management ( UM ) team manages prior authorization and concurrent review for members seeking ... use disorder treatment. The Operations Specialist, Experienced will report to the Sr. Manager, BH UM . In this role you will be the subject matter expert for the BH … more
- 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
- Thomas Jefferson University Hospitals, Inc. (Philadelphia, PA)
- …appropriate acute care days and approve or refer questionable days to the medical director for decision. Function as a liaison between providers, members ... and interdepartmentally. Serve as resource for physicians, PCPs, Utilization Review departments and all medical providers. Identify trends that impact on … 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
- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...relevant experience, including: 2 years previous experience as a Medical Director in a clinical practice. Current… more
- UnitedHealth Group (Phoenix, AZ)
- …Caring. Connecting. Growing together. We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible ... of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level....software and platforms Although the United Health Services ICM Medical Director 's work is typically concentrated in… more
- Franciscan Missionaries of Our Lady Health System (Jackson, MS)
- …followed by appropriate intervention as evidenced by documentation. e. Prompt notification of UM Manager or Director of possible quality or physician issues as ... Job Description The Utilization Review Nurse performs Utilization Review...Evaluation and Analysis: a. Patient cases are reviewed for medical necessity and intensity service/severity of illness to ensure… more
- MetroPlusHealth (New York, NY)
- …working understanding of Utilization Management and the role of a Medical Director , including regulatory requirements. Prior UM administrative ... in the coordination and completion of special projects as appropriate. Coordinates Medical Director group email and chat functionality. Effectively communicates… more
- CenCal Health (Santa Barbara, CA)
- …Summary Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization ... on business needs. Duties & Responsibilities Provides clinical leadership for medical management functions; assists subordinate managers in resolving medical … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The Role: The Medical Clinical Program Manager will focus on utilization management compliance and ... in the organization Apply their clinical knowledge when assessing/auditing medical records and UM letters against ...ability to navigate, interpret, & analyze information from the utilization management medical management data as well… more
- Children's Health (Dallas, TX)
- …admission. * Participates in Quality Improvement projects as directed; performs audits of medical records as directed; and assists the Utilization Review Team ... Job Title & Specialty Area: Prospective Review RN Department: Utilization Management Location: Dallas Shift: Day Job Type: Remote (This position does require on site… 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
