- NHS Management (Prattville, AL)
- …Assists assigned facilities in accurately recording skilled services in the MDS and medical chart and providing rehab services at the highest practicable level for ... each resident. Provides case management services for certain high-risk Medicare Part A residents...areas of general nursing, rehabilitation and restorative nursing, including medical practices in long term care Has a minimum… more
- Shannon Health (San Angelo, TX)
- …by ensuring your CV and skills are a good match. Provides diagnostic medical nuclear medicine services that are consistent with clinical education and training in ... and consults with the supervisor, manager, or team member when appropriate. Time Management : Works efficiently and manages duties to ensure that tasks are completed… more
- Geisinger (Danville, PA)
- …of department and service line policies. Participates in departmental strategic planning, utilization management , and implementation of the strategic plan. Acts ... with departmental administration through regularly scheduled meetings and confers with the medical staff members, Operations Manager and Department Director on… more
- HCA HealthONE Rose (Denver, CO)
- …and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a ... health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability… 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 ... Job Description This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services...leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. Primary Duties and… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception ... required by law. Alternate locations may be considered. The ** Medical Director ** is responsible for reviewing cases...and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license… more
- Wellpath (Cleveland, OH)
- …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
- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , ... policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Humana (Raleigh, NC)
- … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... 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 (Washington, DC)
- … 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 (Madison, WI)
- …a regional role that primarily supports the Aetna Better Health Plan of Oklahoma. 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
- Fallon Health (Worcester, MA)
- …of care opportunities related to Utilization Management . + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and...leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient 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 ... Executive Director works closely with leaders from various departments-case management , physician advisors, revenue cycle, medical staff, nursing, and… 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 ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but… 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
- Mount Sinai Health System (New York, NY)
- … Director (Licensed)** is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and value-based care populations. This ... **Experience Requirements** + 7+ years of experience in care management , utilization management , population health,...Sinai Health System is one of the largest academic medical systems in the New York metro area, with… more
- Centene Corporation (Richmond, VA)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... Integra's Utilization Management (UM) operations. This full-time, salaried...committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's… 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 ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management...UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical … more
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