- AmeriHealth Caritas (Newtown Square, PA)
- …administrative services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, … more
- Humana (Dover, DE)
- … Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the ... 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 (Dover, DE)
- … 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 (Dover, DE)
- … 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 (Dover, DE)
- … Director , depending on size of team 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 fundamentals of CMS...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Dover, DE)
- **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
- The Cigna Group (Philadelphia, PA)
- **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
- AmeriHealth Caritas (Dover, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer...in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Zurich NA (Dover, DE)
- …+ 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...the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds'… more
- AmeriHealth Caritas (Philadelphia, PA)
- …and goals. Following the shift care workflow the case is presented to the Medical Director for medical necessity review. Upon approval of services, ... pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience… more
- Centene Corporation (Dover, DE)
- …of coordination with State agencies. ** Medical Leadership and Oversight:** + Provide medical leadership for utilization management , case management , ... improvements in the LTSS and Medicare-Medicaid Duals populations. ** Utilization Management & Quality Improvement:** + Provide medical expertise in the… more
- Evolent (Dover, DE)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...practice of Orthopedic Spine Surgery is preferred. + Administrative Medical Experience- Utilization Management , Leadership… more
- Evolent (Dover, DE)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Evolent (Dover, DE)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Dover, DE)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Terumo Medical Corporation (Elkton, MD)
- …and overseeing all project management operations across multiple regions of Terumo Medical Corporation, reporting to the Senior Director of the Project ... Director , Project Management Date: May 22,...Req ID: 4806 Location: Elkton, MD, US Company: Terumo Medical Corporation Department: PM&PD Management Terumo … more
- Humana (Dover, DE)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Dover, DE)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Evolent (Dover, DE)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- IQVIA (Wayne, PA)
- ** Director , Strategic Account Management ** The **Digital Products & Solutions (DP&S)** business unit at IQVIA is a function-led organization encompassing ... design, implementation, post-implementation support, and technical advisory services. As ** Director , Strategic Account Management ** within the **Clinical Trial… more