- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical...Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in ... related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs.… 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, ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Director of Utilization Review (UR) in a behavioral health setting oversees the UR process, ensuring appropriate and cost-effective care while adhering to ... collaborating with clinical staff to ensure optimal patient outcomes. Overseas utilization management and criteria-based reviews of care, clinical appeals regarding… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Intermountain Health (Las Vegas, NV)
- …management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership ... with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines and for assuring that quality medical care is being… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the Director for Utilization … more
- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice for… 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...Nurse will route the case to the UR Medical Director . The UR Medical Director will review… more
- The Cigna Group (Bloomfield, CT)
- …for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate contracting efforts to ensure ... alignment across formulary, utilization management, SafeGuard, and other trend solutions. **Essential Functions:** + Ability to manage development and execution of… 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 ... for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key...+ Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed… more
- Commonwealth Care Alliance (Boston, MA)
- …decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to… more
- Ochsner Health (New Orleans, LA)
- …comply with Federal and State regulations/quality initiatives. Reports to the System Medical Director of Utilization . This job description is a summary of the ... at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management) serves as the physician leader in matters relating to patient… more
- HonorHealth (AZ)
- …hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management, Nursing, the Chief Medical Officer and the AVP ... more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for departmental assessment, problem… more
- Gentiva (Mooresville, NC)
- …Manager** to join our team. This position will directly report to the Director of Utilization Management and is responsible for planning, coordinating, ... related to PPD vendors: medical supplies, durable medical equipment, and pharmacy utilization . + Works closely with branch leadership to identify and deploy… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Assistant Director of Case Management supports the Director of Case Management with the overall operation of the Case Management ... Department. At the direction of the Director , this includes oversight of daily activities plus the forward planning of successful strategies to assure timely and… more
- Prime Healthcare (Inglewood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/ director -of-case-management utilization ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Corewell Health (Grand Rapids, MI)
- …in coordination with external partners and reports directly to the Senior Director of Utilization Management. Essential Functions Strategic Leadership & Program ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...Develop and implement operational plans to improve LTSS access, utilization , and quality. + Lead initiatives to align LTSS… more
- Humana (Dover, DE)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... 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 … more
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