- 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 ... collaborating with clinical staff to ensure optimal patient outcomes. Overseas utilization management and criteria-based reviews of care, clinical appeals regarding… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… 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...the UR Medical Director . The UR Medical Director will review the case and may… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... optimal patient level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the Director for … more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership with MG Clinical… more
- UTMB Health (Friendswood, TX)
- …trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review /Case Management. + Maintains a documentation ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,… more
- Commonwealth Care Alliance (Boston, MA)
- …The Manager, Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior ... Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
- Elevance Health (Walnut Creek, CA)
- …must live in California. The **Medical Director ** will be responsible for utilization review case management for Medicare and Medicaid in the California ... **Medical Director - Medicare and Medicaid** Location: This role enables...state or territory of the United States when conducting utilization review or an appeals consideration 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
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... **Job Description** The Assistant Director of Case Management supports the Director...the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Assistant… 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 ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/ director -of-case-management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital… more
- Wellpath (Lemoyne, PA)
- …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
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… 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 ... and implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames + Documents… more
- University of Utah Health (Salt Lake City, UT)
- …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
- Elevance Health (Morgantown, WV)
- …Hours** : Monday through Friday, 8am - 5pm The **Medical Management Nurse** (Medicaid Utilization Review ) is responsible for review of the most complex ... treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...which have been referred to the physician for peer-to-peer review with the Medical Director of the… more
- Trinity Health (Columbus, OH)
- …of the Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. + ... analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the...Coordinates with Medical Director /Associate Medical Directors on case-specific issues. + Coordinates with… more
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