- AmeriHealth Caritas (Newtown Square, PA)
- …administrative services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, … more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Intermountain Health (Las Vegas, NV)
- …, care management , claims, network management , and finance. As the Medical Director for Utilization Management , you are responsible, in ... quality improvement efforts. Serves as the chair of Quality Medical Management Committee (QMMC) and other designated...timely documentation and reporting. + Demonstrated knowledge of case management , utilization management , quality … more
- Wellpath (Lemoyne, PA)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
- HonorHealth (AZ)
- …agencies, other hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management , Nursing, the Chief ... Learn more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for...contacts to assure quality service is provided. Partners with medical staff to assure proper utilization of… more
- Integra Partners (Troy, MI)
- …Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case... Nurse will route the case to the UR Medical Director . The UR Medical … more
- Humana (Dover, DE)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Springfield, IL)
- …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). This...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Humana (Charleston, WV)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Concord, NH)
- … Director , depending on size of team or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Springfield, IL)
- …a regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... the Enterprise. The individual works in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders...and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role… 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... Utilization Review functions working closely with other medical management team members. + Support the… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- Humana (Pierre, SD)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...data received from external agencies, Physician Advisors and the Medical Director . 10. Works collaboratively with Admitting,… more
- Prime Healthcare (Inglewood, CA)
- …director -of-case- management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens… more
- San Antonio Behavioral Health (San Antonio, TX)
- …and collaborating with clinical staff to ensure optimal patient outcomes. Overseas utilization management and criteria-based reviews of care, clinical appeals ... The Director of Utilization Review (UR) in...review process while monitoring the timeliness and accuracy of utilization management data and reporting. Leads … more
- Elevance Health (Seattle, WA)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Management ** **Outpatient Rehab Utilization Management ** **Virtual:** This ... Operations Associate Medical Director ** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions… more
- The Cigna Group (Bloomfield, CT)
- **Overall** Responsible for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate ... contracting efforts to ensure alignment across formulary, utilization management , SafeGuard, and other trend solutions. **Essential Functions:** + Ability to… more
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