- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but… 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 ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- … Management Coordinator. The Utilization Management Coordinator will report to the Director of Utilization Review and will be responsible to provide ... quality case management services to all patients and their families, to serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy, and assure the deliverance of quality treatment to patients and their families.… more
- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the medical ... for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical effectiveness… more
- Fallon Health (Worcester, MA)
- … Director to identify and prioritize the cost of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related ... of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Cleveland, OH)
- …Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and practice ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management Team consisting… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Utilization Management Medical Director - Indiana...reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... to make a difference, join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is responsible for the design, strategic… more
- Insight Global (New York, NY)
- …practice medicine is required. * 3+ years of clinical practice * 2+ years of utilization review experience in a managed care plan (health care industry) referred ... * Use correct templates for documenting decisions during case review . * Receive and review escalated reviews....for clinical reviews. * Collaborate with other departments on Utilization Management Operations. * Lead key projects and drive… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions + Partner with technology and data teams to refine data… more
- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- Arms Acres (Carmel, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...tasks requested by the UR Manager, CEO or Medical Director to meet the needs of the Center. Perform… more
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