- Wellmark, Inc. (Des Moines, IA)
- …benefit offerings here. Job Description About the opportunity: As Senior Medical Director for Utilization Management ( UM ), you will be an effective ... Additional Information What you will do as a Sr Medical Director - Utilization Management:...UM process and outcomes in close partnership with Director , UM in Health Services. b. Demonstrate… more
- Connecticut Children's (Hartford, CT)
- …UR Team Lead has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity determinations. Lead ... Job Description The Team Lead for Utilization Review (UR) is responsible for the day-to-day...and support of the Manager of Case Management and Director of the Center. Provides leadership and direction around… more
- CHPW (Seattle, WA)
- …against criteria utilized for medical review. Regularly communicates with the UM Manager, Medical Director , physician advisor/reviewer and primary care ... The Level I Utilization Management Clinician performs utilization review for medical or behavioral health...not meet medical necessity or criteria for medical director review. Communicate effectively with … more
- Tucson Medical Center (Tucson, AZ)
- SUMMARY : Under the direction of the Director of Professional Staff Services, the Utilization Manager acts as a liaison to hospital leadership, Case Management, ... This position is part of an interdisciplinary team consisting of the Director of Professional Staff Services and Utilization Management Physician Advisors… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and to pivot from a "job" opportunity to an authentic experience! The Medical Director of Behavioral Health is responsible for clinical oversight, clinical ... but are not limited to, case management, quality management, utilization management ( UM ), and grievance and appeals...), and grievance and appeals and committee participation. The Medical Director of Behavioral Health oversees the… more
- CorrHealth (Fort Collins, CO)
- Director of Nursing Location: Fort Collins Schedule: Primarily M-F, with flexibility to support business needs Pay range: $110-114k/annually FT Benefits, including ... 75% Medical Insurance premium paid for you and your qualifying...you and your qualifying family members Position Overview The Director of Nursing is predominantly in charge of managing,… more
- Liberty Health (Wilmington, NC)
- …on fax and authorization queues, and other documents incoming and outgoing. Assist Utilization Management RNs and Director with projects as needed. Attend and ... to all internal Utilization Management meetings Ability to be an interactive UM team member to ensure compliant execution of UM program Review admissions… more
- PacificSource (Bend, OR)
- …Management and Utilization Management Manager, as needed. Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the ... to 5:00pm Essential Responsibilities: Work closely with the HS Director and other HS Managers to facilitate the development...utilization management process to include; coordination of prior authorization… more
- Iconma LLC (Syracuse, NY)
- …determine coverage under the member's benefit. Routes cases directly to the pharmacist/ medical director for final determination, as directed. Issues verbal and ... written member notification as required. Reviews and interprets prescription and medical benefit coverage across all lines of business including Medicare D to… more
- Copa Health (Magna, UT)
- …barriers to quality care and opportunities for improvement and reports them to the Director of Nursing. Participates in UM and QI activities as required. Reads ... for educational advancement. Affordable Health Care Plans : Choose from comprehensive Medical , Vision, and Dental plans. Flexible Spending Accounts : Utilize HSA,… more
- Dignity Health (Rancho Cordova, CA)
- …review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician Reviewers. - Tracks cost savings from ... home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director the Supervisor of Utilization Management is responsible and… more
- Actalent (Redlands, CA)
- Job Title: UM CoordinatorJob Description The Utilization Management ( UM ) Coordinator is responsible for executing all aspects of the referral process. The ... based on clinical protocols. This role involves effective communication and interaction with utilization review nurses and health plans regarding UM and referral… more
- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... for accessibility within the network. - Consults with the medical director on cases that do not...information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. -… 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)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...region. Key Responsibilities + Leadership & Management**: + Oversee Utilization Management ( UM ) across assigned hospitals, ensuring… 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 Review Medical Director will be responsible for providing leadership and subject...for providing leadership and subject matter expertise to our utilization management ( UM ) group. This role is… 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
- 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
- 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...Management Nurse will route the case to the UR Medical Director . The UR Medical … more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the...critical to the success of our members and the Utilization Management ( UM ) department in realizing its… more
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