- Geisinger (Danville, PA)
- …of department and service line policies. Participates in departmental strategic planning, utilization management , and implementation of the strategic plan. Acts ... total patient care and employee satisfaction. Collaborates with the department Director and operational leadership to assure a coordinated effort in instituting… more
- 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 (Birmingham, AL)
- …patient care, supervising, directing and developing nurse staff, and reporting to the Director of Nursing to ensure quality patient care within a long-term care ... subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident care and… more
- NHS Management (Madison, AL)
- …patient care, supervising, directing and developing nurse staff, and reporting to the Director of Nursing to ensure quality patient care within a long-term care ... subordinate nurses engaged in quality assurance, infection control, and utilization review activities. Receives physicians' instructions regarding resident care and… 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
- 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
- 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...or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental… 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,...at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… 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)
- … (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… 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 ... Internal Medicine, and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license or the ability… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… 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 ... strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. Primary Duties and Responsibilities *… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- Intermountain Health (Las Vegas, NV)
- …work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national , and regulatory ... Care Management I reports to the Care Management Director . **Position Details** + Full Time...Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred… more
- LA Care Health Plan (Los Angeles, CA)
- …Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department ... Utilization Management Nurse Specialist RN II...reports are maintained and referred to the Physician Advisor/UM Director . Document in platform/system of record. Utilize designated software… more
- LifeCenter Northwest (Bellevue, WA)
- …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more
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