- Premera Blue Cross (Mountlake Terrace, WA)
- …We are seeking an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their ... addition, they will support clinical programs (disease and case management ), as well as the review and adoption of...of Internal Medicine is preferred for the Assistant Medical Director with an Oncology focus. (Required) + Unrestricted Washington… more
- Katmai (Fort Carson, CO)
- …Bachelor of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- Organon & Co. (Annapolis, MD)
- **Job Description** **The Position** The Regional Payer Account Director (RPAD) reports directly to the Executive Director , Regional Payer Accounts. The RPAD ... generating potential solutions that enhance partnership. Collaborating with the National Account Director , the RPAD participates in the development of, as well as… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... in provider relations, contracting, or network operations, including 3-5 years in a director or senior management role. - Experience with value-based payment… more
- Stony Brook University (Stony Brook, NY)
- …Flow Cytometry & Lyme Laboratory sections). Under the direction of TH Assoc Technical Director , she /he will be responsible for oversight of the operations to ensure ... ensure efficient workflow under the direction of the SL-5 Associate Technical Director , Immunology Laboratory. This includes ensuring test results are timely and all… more
- Oregon State University (Astoria, OR)
- …Youth Development program. This 4-H Program Coordinator reports to the Regional Director assigned to the Coastal Region. Decisions regarding this position are made ... the supervision team which includes the 4-H Youth Development Director /Program Leader and the Coastal Regional Director ..... This 4-H Program Coordinator is responsible for the management , promotion, and delivery of a diverse portfolio of… more
- Cordis (Chicago, IL)
- …Business) through direct case support. ?Reports to National Clinical Sales Director .? **Responsibilities** + Responsible for meeting revenue generation targets on ... or annual basis. + Focused on driving depth and increasing Cordis product utilization in existing accounts through the cultivation of new physician users and… more
- Fallon Health (Worcester, MA)
- …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… 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
- Integra Partners (Troy, MI)
- …funded programs; no OIG sanctions + 5+ years of utilization management experience, including complex case review + Prior leadership experience overseeing ... (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests + Develop strong ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
- LifeCenter Northwest (Bellevue, WA)
- …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...progressive discipline process when appropriate * Collaborates with department director and professional development specialist to develop standard work… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
