- LA Care Health Plan (Los Angeles, CA)
- …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- CVS Health (Columbus, OH)
- …urgent cases can be done from your laptop. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a medical director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
- CVS Health (Springfield, IL)
- …with the schedule and open to discussion. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a Medical Director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
- YesCare Corp (Hanover, MD)
- …Shares information gathered at the quarterly area multidisciplinary CQI Committee meetings with the Utilization Management Medical Director to be used at ... Nurse in Maryland. + Current Basic Life Support/CPR Certification at the Medical Professional Level with AED Training. American Heart Association is the preferred… more
- AmeriHealth Caritas (Newark, DE)
- …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the CMO. The following ... years of clinical practice experience. + Experience in Utilization Management as a Medical Director within a managed care organization preferred. +… more
- Geisinger (Scranton, PA)
- … management of the Utilization Review policy and observation management performance including outcomes of medical necessity justification with health plan ... Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of… more
- Elevance Health (Columbus, OH)
- **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign ... set of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director supporting our Medical Oncology team** is… more
- CVS Health (Springfield, IL)
- …support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization… more
- Humana (Columbus, OH)
- … 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 ...managed care experience working with LTSS program population. + Utilization management experience in a medical… more
- Point32Health (MA)
- …and liaises with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director , pharmacy, community health ... CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care,...ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works… more
- Humana (Columbus, OH)
- … 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
- Humana (Columbus, OH)
- … 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 (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...for medical staff on issues related to utilization management . 1. Implements utilization … more
- Trinity Health (Boise, ID)
- …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and ... and consistent with all PH&S policies and procedures. + Provides expertise in Utilization Management to Nursing and Medical Staff; Is viewed as a resource… more
- Regis HR Group (Miami, FL)
- …trains and disciplines staff to ensure smooth operations in utilization management . + Also facilitates educational training for medical staff on issues ... Develops, manages and directs the Utilization Management programs for the primary... trends, patterns, and impact to appropriate departmental and medical staff committees. + Assures compliance with Federal, State,… more
- Universal Health Services (Sacramento, CA)
- Responsibilities Sierra Vista Hospital is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare ... inpatient alcohol detox and outpatient chemical dependency services. Position Summary: The Clinical Director of Utilization Management is responsible for the… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Ascension Health (Austin, TX)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and...Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell… more