- BroadPath Healthcare Solutions (Tucson, AZ)
- …staff on managed care and Medicaid policies and procedures D. Conducts staff and medical director audits on appeal activities + Assists with appeal file ... **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical … more
- Commonwealth Care Alliance (Boston, MA)
- … Utilization Management team in managing and continuously improving UM program design, policies, procedures, workflows, and correspondence. - Supports provider ... a minimum five (5) years of leadership experience in Utilization Management ( UM ) or nursing leadership to...- Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- Dignity Health (Bakersfield, CA)
- …the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management ( UM ) and the Medical ... as providing clinical leadership and guidance to other physician medical directors within the UM department, ensuring...and Clinical Oversight functions. + Oversee and manage the medical director capacity to support Managed Care… more
- Humana (Little Rock, AR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
- CenterWell (Boston, MA)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The… more
- Humana (Jefferson City, MO)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
- CVS Health (Springfield, IL)
- …that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- UPMC (Pittsburgh, PA)
- …verbal and/or written notification to providers as applicable. Consult with health plan medical director to discuss medical necessity for requested service. ... review requests for authorization for behavioral health services. The Utilization Management ( UM ) Care Manager is responsible...plan or level of service. Consult with health plan medical director on an as needed basis… more
- CVS Health (Trenton, NJ)
- …Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Medicaid plan and the UM team. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… 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 ... nursing, and information systems (ISD) to create a unified and standardized utilization management ( UM ) infrastructure. This collaboration ensures the delivery… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... patient care and the appropriate utilization of medical services. The Medical Director ...admissions. + Evaluate and recommend policy improvement related to utilization reviewsystem, andprovide UM updates and participate… more
- Commonwealth Care Alliance (Boston, MA)
- … Utilization Management team in managing and continuously improving UM program design, policies, procedures, workflows, and correspondence. * Supports provider ... a minimum five (5) years of leadership experience in Utilization Management ( UM ) or nursing leadership to...* Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- LA Care Health Plan (Los Angeles, CA)
- …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- CommonSpirit Health (Phoenix, AZ)
- …will be an expert on matters regarding physician practice patterns, over and under- utilization of resources, medical necessity, levels of care, care progression, ... **Essential Key Responsibilities:** + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …Associate Director of Patient Care Services and ultimately the Associate Director of Patient Care Services (ADPCS). The Utilization Management/Float (RN) ... Summary The Miami VA medical Center is looking for recruit for Registered Nurse - Utilization Management / Float who is responsible and accountable for all… more
- LA Care Health Plan (Los Angeles, CA)
- …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- Guthrie (Cortland, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... Summary The LPN Utilization Management ( UM ) Reviewer, in collaboration...time frames. Knowledge of health benefit plans and related UM requirements preferred. Experience with CPT/ICD coding, medical… more
