- CHPW (Seattle, WA)
- …against criteria utilized for medical review. Regularly communicates with the UM Manager, Medical Director , physician advisor/reviewer and primary care ... cases that do not meet medical necessity or criteria for medical director review. Communicate effectively with medical director regarding identified… 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 ... ( UM ), and grievance and appeals and committee participation. The Medical Director of Behavioral Health oversees the inpatient/concurrent review process,… 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)
- …and other documents incoming and outgoing. Assist Utilization Management RNs and Director with projects as needed. Attend and contribute to all internal Utilization ... Management meetings Ability to be an interactive UM team member to ensure compliant execution of UM program Review admissions and service requests for the… 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 that… more
- PacificSource (Bend, OR)
- …Care Management and Utilization Management Manager, as needed. Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the ... - Friday 8:00am to 5:00pm Essential Responsibilities: Work closely with the HS Director and other HS Managers to facilitate the development and implementation of new… more
- The University of Miami (Miami, FL)
- …Meets requirements of Clinical Trials Chemotherapy Nurse 50% Works closely with the medical director and the pediatric nursing director . Administers research ... clinic is well prepared consisting of all supplies and medical records (print and electronic) are up to date...Hospital Wide Magnet Accreditation vision and process. Compliance with UM , Hospital and department policies and procedures Other duties… more
- Connecticut Children's (Hartford, CT)
- …under the guidance and support of the Manager of Case Management and Director of the Center. Provides leadership and direction around scheduling, supervision and ... criteria to screen for appropriateness of level of care based on medical record documentation. -9% Gathers clinical information to conduct continued stay utilization… more
- WELLSPACE HEALTH (Sacramento, CA)
- …Sacramento, CA Description Clinical Care Manager Department: Nexus Location: 164 Reports to: UM Director Status: Full-Time FLSA: Non-Exempt Pay Range: $101,100 - ... always been to offer a full range of quality medical care, dental care, mental health and behavioral health...certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. Position Summary… more
- UnitedHealth Group (Syracuse, NY)
- …PCP, HBMC interdisciplinary teammates and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out ... Consults with hospital physicians following notification of member transfer Collaborates with UM staff and PCPs/facility staff to enable medical necessity… more
- CVS Health (Springfield, IL)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- Elevance Health (Houston, TX)
- **Clinical Operations Associate Medical Director ** **Home Health Utilization Review** **Carelon Medical Benefit Management** **Virtual:** This role enables ... is granted as required by law._ The **Clinical Operations Assocaite Medical Director ** is responsible for supporting the medical management staff… more
- Commonwealth Care Alliance (Boston, MA)
- …with all regulatory, contract and NCQA requirements. + Together with the Director of UM and Sr. Medical Director of medical policy, manage the ... The Manager, Medical Policy reports to the Director of UM , and manages the personnel...development and review and works collaboratively with the Sr. Medical Director of Medical Poliy… 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 ... **Position Summary:** Under the guidance and supervision of the department Manager/ Director the Supervisor of Utilization Management is responsible and accountable… 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 UM ... and interaction with utilization review nurses and health plans regarding UM and referral authorization issues. Responsibilities + Execute the referral process… 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 ... decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider...for accessibility within the network. - Consults with the medical director on cases that do not… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …the Quality Management/Utilization Management (QM/ UM ) Plan, including having the BH Medical Director for Children's Services and participate on the BH ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...clinical setting). + A minimum of ten (10) years medical experience and strong working knowledge of QM/ UM… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- University of Miami (Miami, FL)
- …abdominal organs in approximately 50% of cases. + In conjunction with the Medical Director assumes ultimate responsibility for donor management and the process ... to work in Miami, FL. The Recovery Coordinator 1 ( UM LAORA) assists in the recovery, packaging, preservation and... medical record. + Shares on-call responsibility with Medical Director to oversee clinical evaluation and… more
- Cedars-Sinai (Beverly Hills, CA)
- …member eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management. + Processes… more
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