- MetroPlusHealth (New York, NY)
- …the medical necessity of requested healthcare services Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests ... and objectives in containing health care costs and maintains a high-quality medical delivery system through departmental UM procedures Collects all pertinent… more
- Regal Medical Group, Inc. (Northridge, CA)
- …The Director coordinates, plans and manages staff activities; develops with Medical Director program goals and objectives; makes staff assignments; develops ... and plans for effective patient centered utilization management; together with the medical director , interprets and administers pertinent laws; through direct… 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 ... ( UM ), and grievance and appeals and committee participation. The Medical Director of Behavioral Health oversees the inpatient/concurrent review process,… 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 ... 3+ years relevant experience, including: 2 years previous experience as a Medical Director in a clinical practice. Current clinical knowledge. Experience… 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 ... in all required software and platforms Although the United Health Services ICM Medical Director 's work is typically concentrated in a region, they are… more
- IPG Mediabrands (Los Angeles, CA)
- …are looking for a people-first organization that can offer you the career you crave, UM is your home. We are the destination of choice for the world's best talent, ... are hungry for personal growth and continuous learning. People who thrive at UM are collaborators by nature who pursue diverse perspectives because they understand… more
- University of Maryland Medical System (Bel Air, MD)
- …of Maryland Upper Chesapeake Health owns and operates: University of Maryland Upper Chesapeake Medical Center ( UM UCMC), Bel Air, MD The Upper Chesapeake Health ... Company Description University of Maryland Upper Chesapeake Health ( UM UCH) offers the residents of northeastern Maryland...Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern… more
- MetroPlusHealth (New York, NY)
- …of Utilization Management and the role of a Medical Director , including regulatory requirements. Prior UM administrative coordination experience in ... 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)
- …Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, ... on business needs. Duties & Responsibilities Provides clinical leadership for medical management functions; assists subordinate managers in resolving medical … 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 mental ... Specialist, Experienced will report to the Sr. Manager, BH UM . In this role you will be the subject...least two (2) times per month (for roles below Director -level) or once per week (for Director -level… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to various levels in the organization Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity ... Bring your true colors to blue. The Role: The Medical Clinical Program Manager will focus on utilization management...deliverables with minimal support; keep project/ workgroup leads and Director informed of key issues/ risks and meet deadlines… more
- Children's Health (Dallas, TX)
- …Ambulatory clinics and Patient Access Service areas; assisting in reviewing medical records for appropriate reimbursement of medically necessary services meeting ... * In collaboration with Patient Access Services, Ambulatory clinics and UM leadership planning and execution of communication to various facilities, developing… more
- UnitedHealth Group (Brooklyn, NY)
- …PCP, HBMC interdisciplinary teammates and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out ... Consults with hospital physicians following notification of member transfer Collaborates with UM staff and PCPs/facility staff to enable medical necessity… more
- The University of Miami (Miami, FL)
- …ADDENDUM Department Specific Functions Provide support for Radiology Division director and it's division members: Travel Requests and Business Reimbursements: ... for assigned faculty members. Administrative Support: Assist in faculty on-boarding (ID Badge for UM and JHS, access, lab-coats, Scrub access At UM and JHS… more
- University of Maryland Medical System (La Plata, MD)
- Company Description At University of Maryland Charles Regional Medical Center ( UM CRMC), our talented and diverse groups of professionals represent our strength. ... in a clean, orderly and safe manner according to established procedures; advises Director of equipment malfunctions. Maintains testing rooms and work area in a… 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 ... to review clinical information provided by facilities and communicates UM determinations maintaining timeliness. Job Description Primary Responsibilities: Review and… more
- Liberty Health (Wilmington, NC)
- …and other documents incoming and outgoing. Assist Utilization Management RNs and Director with projects as needed. Attend and contribute to all internal Utilization ... Management meetings Ability to be an interactive UM team member to ensure compliant execution of UM program Review admissions and service requests for the… 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 ... written complaints. Evaluation and Analysis: a. Patient cases are reviewed for medical necessity and intensity service/severity of illness to ensure patient is… 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 ... Prior Authorization LVN is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and… more
- CVS Health (Springfield, IL)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
