- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient &… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… more
- Huron Consulting Group (Chicago, IL)
- …standards. + Participate in quality assurance activities to improve utilization management processes and patient care outcomes. + Lead UM Denials Team ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...daily Staff Huddles for operations and priorities review. + Lead Patient Care Management Escalation Huddles to… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Dignity Health (Bakersfield, CA)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, ... **Preferred Qualifications:** - Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified in Internal Medicine… more
- HCA Healthcare (Campbell, CA)
- …purpose and integrity. We care like family! Jump-start your career as a(an) Utilization Management RN today with HCA Healthcare. **Benefits** HCA Healthcare, ... vary by location._** Come join our team as a(an) Utilization Management RN. We care for our...experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible and accountable...RN Case Managers for in inpatient care coordination and utilization review. Oversees interactions of staff with outside activities… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... RN licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill / Aptitudes** Understanding… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and scholar at the ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . + Provides clinical guidance as a Nurse… more
- Cedars-Sinai (CA)
- …collaborative patient management under the direction of a board certified/eligible physician . The Lead PA is responsible for implementing and maintaining APP ... health, valve disorders, arrhythmia and hypertension. **Summary of Essential Duties:** The Lead Physician Assistant (PA) in the Department of Cardiac Surgery… more
- Stanford Health Care (Palo Alto, CA)
- …one of the Nation's most prestigious Cardiothoracic Surgery teams as an APP Leader. You will lead a team of APPs as well as have your own OR and Clinic time. We ... mission one patient at a time. **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… more
- Trinity Health (Athens, GA)
- …in a hospital setting and a minimum of 1 year in case management , utilization management , or discharge planning preferred. **Special Qualifications:** ... and concurrent chart reviews on Federal and self-payers for the purpose of utilization review as well as identifying patients requiring case management … more
- Catholic Health Services (Melville, NY)
- …and management ; contributes to completion of project status reports. Lead meetings with staff and/or leadership to assist in establishing project priorities ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...and managing resources) and all phases of the project management life cycle for a variety of initiatives Actively… more
- Kepro (CA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary As a… more
- SSM Health (Oklahoma City, OK)
- …for Care Transformation including serving as primary lead for the governance for Utilization Management . + Oversees and is responsible for utilization ... expert, providing medical direction and oversight to care management , utilization management andclinical documentation... physician coaching for all activities of care management , utilization management , and clinical… more
- Mohawk Valley Health System (Utica, NY)
- …range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job...PREFERRED: + Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2… more
- Mount Sinai Health System (New York, NY)
- …VMSCCC; Director, Oncology Surgical Services; the co-Directors of Radiation Oncology; and the Lead APP for Oncology + Support physician within VMG Oncology ... trust and confidence with utmost integrity + Ability to lead change and build consensus to support change +...support VHS initiatives in cost containment, product standardization, resources utilization and supply chain management (HIM Queries,… more
- SSM Health (St. Louis, MO)
- …transformation including serving as primary lead for the governance for utilization management . + Recruits, engages, develops, leads, and manages assigned ... expert and provides medical direction and oversight to care management , utilization management and clinical... physician coaching for all activities of care management , utilization management , and clinical… more
- Kepro (AR)
- …team. Job Summary: The Dental Physician Reviewer-Oral Surgeon will oversee utilization review/ management activities to include peer review, utilization ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...Reviewers on case consultations as needed. + Discuss complicated Utilization Management reviews or clinical scenarios with… more