- 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
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... optimal patient level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role of the Director … 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
- Prime Healthcare (Riverdale, GA)
- …Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Director of Utilization ... on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military... utilization review and clinical appeals process. The Director of Utilization Management will… 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 ... **Job Description** The Assistant Director of Case Management supports the... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- Ascension Health (Nashville, TN)
- …TN market. Must be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -... to optimize patient care and partner with the National Senior Director of UM to align… more
- Prime Healthcare (Inglewood, CA)
- …credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/ director -of-case- management utilization - management ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patiens… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical… more
- Commonwealth Care Alliance (Boston, MA)
- … will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping ... other medical management team members. + Support the development of utilization management policy initiatives. + Support the development and implementation… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Intermountain Health (Las Vegas, NV)
- … management , claims, network management , and finance. As the Medical Director for Utilization Management , you are responsible, in partnership with ... + Demonstrated timely documentation and reporting. + Demonstrated knowledge of case management , utilization management , quality management , discharge… 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...Nurse will route the case to the UR Medical Director . The UR Medical Director will review… 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
- Commonwealth Care Alliance (Boston, MA)
- …of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Ochsner Health (New Orleans, LA)
- …at Ochsner Health and discover your future today!** The Physician Advisor (PA- Utilization Management ) serves as the physician leader in matters relating ... Interdisciplinary and Post-Acute teams, Payors, Administration and Revenue Cycle) to improve utilization management , sustain quality goals, and act as a… more
- Banner Health (AZ)
- …benefits, better opportunities and a better community. As a **Registered Nurse RN Utilization Management Care Reviewer,** you will be working in partnership with ... the Medical Director , to evaluate patient care, conduct reviews, and identify...coordination upon discharge from facilities. **The Registered Nurse RN Utilization Management Care Reviewer position is a… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth...in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is required. + Managed care experience is strongly preferred, especially experience in utilization management . In lieu of managed care experience, proven record ... and documentation of findings for submission to the medical director for final determination, as required by law. +...years' experience in a managed care setting, specifically in utilization management . + Experience and skillset in… more
- Sharp HealthCare (San Diego, CA)
- …The UM Care Coordinator, under the direct supervision of the Supervisor, Utilization Management Care Coordinators, prepares referral requests for outpatient ... care, as it related to the position.Bring to attention of the Supervisor, Utilization Management Care Coordinators, and UM Manager, areas of UM non-compliance… more
- Zurich NA (Raleigh, NC)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more