- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- UPMC (Pittsburgh, PA)
- …UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford Macomb… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Centene Corporation (Sacramento, CA)
- …experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... not required. Alternate locations may be considered. The **Medical Director ** will be responsible for utilization review...The **Medical Director ** will be responsible for utilization review case management for North Carolina… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Bassett Healthcare (Cooperstown, NY)
- …secures financial and human resources for the department. Oversees and works with the Director of Utilization Management to support and implement the goals ... director is responsible for the oversight of case management and logistics activities for the Bassett Healthcare Network...of the utilization management program. Maintains oversight responsibility for… more
- Humana (Indianapolis, IN)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Little Rock, AR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Humana (Lansing, MI)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... skills, with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation.… more
- Dignity Health (Bakersfield, CA)
- …, remote patient monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Elevance Health (Overland Park, KS)
- …clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... ** is responsible for serving as the Operational Medical Director for our care management models for...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more