- 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
- 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
- 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
- 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
- The University of Miami (Miami, FL)
- …the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using ... and other presentation materials. Responds to routine inquiries from external or internal sources with standard correspondence or other messaging. Plans meetings and… 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
- Liberty Health (Wilmington, NC)
- …queues, 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… more
- University of Miami (Miami, FL)
- …abdominal organs in approximately 50% of cases. + In conjunction with the Medical Director assumes ultimate responsibility for donor management and the process ... the LAORA electronic medical record. + Shares on-call responsibility with Medical Director to oversee clinical evaluation and management of potential organ… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …the Quality Management/Utilization Management (QM/ UM ) Plan, including having the BH Medical Director for Children's Services and participate on the BH ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...clinical setting). + A minimum of ten (10) years medical experience and strong working knowledge of QM/ UM… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... Officer. **Required Qualifications** + Doctor of Medicine (MD) - Internal Medicine or Family Practice + **OR** Doctor of...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… 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 role ... utilization, and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...Collaboration + Serve as a liaison and consultant for internal UM functions, promoting effective communication 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 ... supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director ...care experience - Board certification in Family Medicine 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
- University of Maryland, Baltimore (Baltimore, MD)
- …Professor level (non-tenure track) to join our dynamic team and serve as Medical Director of our vibrant community-based academic radiation oncology practice at ... **Faculty* **Organization:** **School of Medicine - Clinical Departments* **Title:** * Medical Director Assistant/Associate Professor Community-Based Physician Faculty*… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- Humana (Montgomery, AL)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... look at appeals rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations and Technology_ _:_… more
- CVS Health (Hartford, CT)
- …of the Medical Directors will be a part of the rotation. The Medical Director will be responsible for overseeing the utilization review for health systems ... performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have...of the states in the New England Region *Previous UM experience with a Health Plan / Payor. *Previous… 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 salaried, ... on applicable criteria (ie LCD, InterQual, NY Medicaid Manual, Internal policies, member handbooks) + Upon an enrollee's individual...Management Nurse will route the case to the UR Medical Director . The UR Medical … 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...leadership and subject matter expertise to our utilization management ( UM ) group. This role is a key role in… more
