- HCA HealthONE Rose (Denver, CO)
- …professional nursing practice through expert clinical practice, strong leadership skills, and management activities. The CNC provides clinical management to the ... needs and available resources on unit. Communicates directly with the director /manager on unit and staff performance issues needing attention. Maintains effective… more
- NHS Management (Athens, AL)
- …care standards through oversight of quality assurance, infection control, and utilization review activities Receive and communicate physician instructions ... leadership, supervision, and guidance to nursing staff while partnering with the Director of Nursing to ensure high-quality resident care. The Weekend Supervisor… more
- 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 ... clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities...OIG sanctions + 5+ years of utilization management experience, including complex case review +… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director ...or past OIG or state sanctions + Experience performing utilization management or clinical review ... 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)
- … 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… more
- Wellpath (Cleveland, OH)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- Humana (Juneau, AK)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director -Care Management Are you exceedingly driven, dedicated, and passionate about caring for your patients? Do you consistently create and nurture… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical… more
- Elevance Health (Nashville, TN)
- …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of ... accommodation is granted as required by law. The **Medical Management Nurse** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- Sharp HealthCare (San Diego, CA)
- …and implement new programs under the direction of the Manager of Integrated Care Management and Director of Health Services. Participates in the development of ... experience, preferably in a managed care setting. **Other Qualification Requirements** + Utilization , Case Management , or Quality Management certification… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... will include every weekend (Saturday and Sunday). The **Medical Management Nurse** will be responsible for review ...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… more
- Fallon Health (Worcester, MA)
- … to identify and prioritize the cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director to set agenda related to UM ... strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care,… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... state or territory of the United States when conducting utilization review or an appeals consideration and...and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Health Services ... ready to make a difference, join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is responsible for the design,… more
- Insight Global (New York, NY)
- …turn-around times for clinical reviews. * Collaborate with other departments on Utilization Management Operations. * Lead key projects and drive initiatives ... leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. Primary Duties and...3+ years of clinical practice * 2+ years of utilization review experience in a managed care… more
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