- AmeriHealth Caritas (Orlando, FL)
- ** Medical Director , UM Review, Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to ... practice in any state licensed in as a medical director . Additional state licensure required in...within 3 months of employment. 5+ yrs clinical practice. UM /Care Coordination exp. preferred. Your career starts now. We… more
- Elevance Health (Las Vegas, NV)
- …plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral health ... of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. **This position… more
- Elevance Health (Louisville, KY)
- …within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral health ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- Elevance Health (Atlanta, GA)
- …50 miles of one of our Elevance Health office locations.** The Medical Director is responsible for the administration of physical and/or behavioral health ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- Intermountain Health (Murray, UT)
- …divisions as needed to implement policies and programs for the Office of the Medical Director to manage the provider panel and to maintain high customer ... satisfaction. This position reports to the Medical Director , SelectHealth. Job Essentials 1. Coverage...updates of the UM Program Description and UM Work Plan. 12. Medical Policy: In… more
- City and County of San Francisco (San Francisco, CA)
- …specifically in the Mental Health Service Center + Supervises medical staff, including UM Medical Director , OCC Nurse Practitioner, and the medical ... health services, including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective leadership and… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- CVS Health (Hartford, CT)
- …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... (ICP) and assisting care management staff as they support of members' physical , behavioral and socioeconomic needs.* Partner closely with the Executive Director… more
- CVS Health (Columbus, OH)
- …resistant illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical ... * Outward facing position to interact and collaborate with medical / physical professional associates, the local...Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and ... monitoring of medical management and quality improvement activities\. **Job Description:** **Job...physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on… more
- Molina Healthcare (Bothell, WA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Nuvance Health (Norwalk, CT)
- …cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. ... Case Managment /Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary… more
- Bright Horizons (Miami, FL)
- As a **Child Care Assistant Director ** , you are a positive influence and natural motivator who enjoys having a hand in all aspects of the success of your center's ... of children, families, and your staff. **Bright Horizons at UM - Canterbury Preschool, located in Miami, Florida, is...located in Miami, Florida, is now hiring an Assistant Director . This role offers a competitive salary of $51,200/year… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
- Intermountain Health (Las Vegas, NV)
- …and education for peer-to-peer reviews, prior authorization reviews, and other education within UM as determined by UM Medical and Operational Leadership. ... Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director...Job Profile: + Trains and educates on medical review activities pertaining to utilization review, claims review,… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... experience in a hospital or HMO setting. Preferred: Managed Care experience performing UM and CM at a medical group or management services organization.… more
- HCA Healthcare (Englewood, CO)
- …a team of daring managers who care without reservations or limits? Our Swedish Medical Center team is looking for a Manager for Case Management. HCA Healthcare is ... members over the course of three years. **Benefits** Swedish Medical Center, offers a total rewards package that supports...more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a… more
- Huron Consulting Group (Chicago, IL)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... utilization of healthcare services by reviewing patient cases for medical necessity, appropriateness, and efficiency of Munson Healthcare's services. This… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... experience in a hospital or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management services organization.… more
- Commonwealth Care Alliance (Boston, MA)
- …productivity standards. The Team Leader works in close collaboration with the manager and Director of the UM team. **What You'll Be Doing:** + Provide oversight, ... Role is Important to Us:** Supervisor & The Team Leader reports to the UM Manager. The Team Leader provides management,oversight and mentorship to team members and… more