- Curative HR LLC (Austin, TX)
- …overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity determinations. The Medical Director will serve ... Summary: Curative is seeking an enthusiastic and highly skilled Medical Director to join our growing team....practice experience. Minimum of 2-3 years of experience in utilization management, medical review , or… more
- UHS (Bethlehem, PA)
- …a multi-disciplinary team while working in a state-of-the-art facility, including EPIC. The Utilization Review Director is responsible for overseeing the ... utilization standards. The Director provides guidance to the utilization review staff, advises on improving productivity, and maintains reporting… more
- EvergreenHealth (Kirkland, WA)
- …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …any time throughout the annual performance cycle. Relationships Reports to Executive Director or Vice President Medical Affairs. Has direct supervisory ... About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk...resources, supporting appropriate use of NNI products and greater utilization of its services Takes a leadership role in… more
- Eisai, Inc (Nutley, NJ)
- …difference. If this is your profile, we want to hear from you. The Associate Director (AD), Global Medical Affairs Training and Education is responsible for the ... for internal medical training content. Train new hires on EMAC organization/ utilization .Provide input into and collaborate with regional and global medical … more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …in EMR systems and meet quality and productivity metrics. Escalate complex cases for Medical Director review as needed. We're Hiring for: General UM ... judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral… more
- Kaiser Permanente (Sacramento, CA)
- …Experience Minimum three (3) years of home care nursing experience or quality utilization review experience. Education Bachelors degree in nursing or related ... of important aspects of patient care through ongoing chart review with pre-established criteria. Reports all occurrences which may...reports for state, federal, and local agencies. Assists the director of quality and utilization management for… more
- UnitedHealth Group (Los Angeles, CA)
- …Clinical Excellence, a national OptumCare team, is currently seeking an experienced National Medical Director to join our growing Value Innovations efforts. This ... will provide expertise and leadership on population, specifically Clinical Documentation Review with expertise in application of DRG coding and clinical operations.… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …stay), concurrent review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community ... rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN)… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …customers. Relationships This position reports into a Vice President or Sr. Director within the National Account Market Access Teams. Internally, this position has ... (Pricing, Contracting, Operations and Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance. External relationships include… more
- UnitedHealth Group (Houston, TX)
- … medical records and determining applicable standards of care. The medical director will Chair the Med/Surg Peer Review Committee and oversee that the ... community care providers to serve Veterans. The Optum Community Care Services (CCS) Medical Director works diligently to oversee clinical quality provided from… more
- Medstar Health (Columbia, MD)
- System Medical Director of Physician Advisor Services MedStar Health is seeking a System Medical Director with at least 10 years' experience to lead our ... and clinical impact across our health system. As System Medical Director of Physician Advisor Services, you'll...program development Review critical cases referred by utilization review and case management teams Guide… more
- Telligen (Boston, MA)
- The Medical Director is responsible for guiding the clinical aspects of Telligen's population health management programs and the clinical decision-making aspects ... reviews to ensure health services given are appropriate and necessary. Serves as the medical expert with peer review and appeals processes. Works closely with… more
- Odell Medical Search (Los Angeles, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Assesses ... Role you will play: The Director of Case Management is responsible for the...assessment and evaluation of data/statistics obtained from an on-going review process. 5. Experience and knowledge in basic to… more
- Baptist Health Care (Pensacola, FL)
- …coordination for the division and working directly with the Interfacility Transport Medical Director regarding medical care protocols, procedures, ... participates in administrative decisions affecting patient care and transport. Assists the Medical Director with advanced skills check-off for the transport team… more
- Athari (New York, NY)
- Under the supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight ... adherence to the care management process. Most broadly, the Director ensures members are receiving the care they need...they need and that staff are addressing the members' medical , behavioral and social needs while ensuring appropriate linkages… more
- Nest Health (Phoenix, AZ)
- Associate Medical Director Phoenix, Arizona What is the purpose of this role? As a member of the market leadership triad, the Associate Medical Director ... health improvement, savings, quality, and family satisfaction. What is the role? The Associate Medical Director (AMD) is a member of the Nest Market leadership… more
- Jamie Grayem (Downey, CA)
- …the standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, patient satisfaction ... Director , Patient Safety & Clinical Risk Management Downey,...the reimbursement structure, and the impacts of changes in medical science to hospital performance, among others; maintaining a… more
- Catholic Guardian Services (Bronx, NY)
- …Foster Care Description Catholic Guardian Services Job Description Title: Senior Director of Social Services, Family Foster Care Programs Reports to: Assistant ... Executive Director Major Duties & Responsibilities: Responsible for the administration...Program, which include regular Family Foster Care (FFC), Special Medical and Developmental Disabilities (SMDD), and Treatment Family Foster… more
- Your Safe Haven (Bedford, PA)
- Executive Director Employment Status: Exempt (Minimum 35 hours/Week) Starting Salary Range : $61,000 - $70,000 Overall Responsibility: Provides leadership to fulfill ... standards. Duties & Responsibilities: Financial Management & Grant Administration Provide input, review , and manage the annual budget and ensure fiscal integrity. *… more
