- Humana (Little Rock, AR)
- **Become 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 work assignments involve moderately complex to complex issues...internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,… more
- Humana (Jefferson City, MO)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Dignity Health (Bakersfield, CA)
- …reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting ... Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your responsibilities include reviewing medical records,… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... Duties: Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical...claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized… more
- Integra Partners (Troy, MI)
- …position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are not limited to: Clinical ... day-to-day clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM ...Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with… more
- CVS Health (Springfield, IL)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization… 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
- CVS Health (Madison, WI)
- …Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses ... supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director ...- Board certification in Family Medicine, General Surgery or Internal Medicine / Pediatrics - Prior UM … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Fallon Health (Worcester, MA)
- …of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation...Represents the Vice President and Senior Medical Director of Clinical Management at internal and… more
- Wellpath (Freehold, NJ)
- …for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization review, ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- University of Michigan (Ann Arbor, MI)
- …UMH-West, and Oakland County + Work in partnership with Head Orthopedic Team Physician for UM Athletics and Medical Director for UM Athletics to ... Associate Director , Sports Medicine Apply Now **Job Summary** Leadership of Sports Medicine at UM Health will be vested in a multi-disciplinary triad leadership… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …/Cost Protection * Accountabilities include the overall value of utilization management ( UM ) product, medical and reimbursement policies, and maintenance of ... characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan,… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community,...State Fair Hearings as needed and state calls. Understand UM and participate in UM front line… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Comprehensive Cancer Center (UMGCCC), located in Baltimore, MD are recruiting for a*full-time Medical Director of the University of Maryland St. Joseph Cancer ... in Towson, MD.**_ Administrative duties and responsibilities of the Medical Director role will include, but not...be board certified or board-eligible by the ABIM in Internal Medicine and Hematology and/or Medical Oncology… more
- Health Care Service Corporation (Richardson, TX)
- …include: 1. Provide direction and vision (in coordination with the VP-BH and Medical Director -BH) on clinical matters with respect to Behavioral Health (BH) ... inclusion, involvement, management, and visibility of the department, both internal and external to HCSC, in all clinical areas;...the activities of Clinical Managers. 6. Work with the Medical Director -BH to organize and ensure appropriate… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Veterans Affairs, Veterans Health Administration (Florence, KY)
- Summary The Clinical Medical Director directly reports the Chief of Primary Care / ACOS and will be responsible for all aspects of medical care delivered to ... information, refer to Required Documents below. Responsibilities The Clinical Medical Director must be able to perform...to perform all services required in the practice of Internal Medicine in the context of the VA system… more