- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- CenterWell (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Molina Healthcare (Phoenix, AZ)
- …+ Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate. + Maintains compliance with federal, state, ... criteria (eg, ASAM, MCG, InterQual). + Computer proficiency and experience with electronic medical record or UM systems. To all current Molina employees: If… more
- Molina Healthcare (Phoenix, AZ)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Phoenix, AZ)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- CommonSpirit Health (Phoenix, AZ)
- …regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental ... + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational goals and regulatory standards.… more
- Humana (Phoenix, AZ)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more