- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership ... Serve as the lead for CCA's Utilization Review functions working closely with other medical ...preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the...UR Medical Director . The UR Medical Director will review the… more
- Intermountain Health (Las Vegas, NV)
- …utilization management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, ... 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review ,… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... optimal patient level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the Director for … more
- San Antonio Behavioral Health (San Antonio, TX)
- The Director of Utilization Review (UR) in a behavioral health setting oversees the UR process, ensuring appropriate and cost-effective care while adhering ... the interaction with claims payment policies and processes. Directs activities related to medical review process while monitoring the timeliness and accuracy of … 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
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational ... leadership in the operational areas of care management, utilization review , appeals, quality improvement and related...policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and… more
- Mount Sinai Health System (New York, NY)
- …influence other services by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data collection, data received ... from external agencies, Physician Advisors and the Medical Director . 10. Works collaboratively with Admitting, Transfer Services and Finance to ensure… more
- Prime Healthcare (Inglewood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/ director -of-case-management utilization ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization … more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Elevance Health (Morgantown, WV)
- …work-life integration. **Work Hours** : Monday through Friday, 8am - 5pm The ** Medical Management Nurse** (Medicaid Utilization Review ) is responsible for ... whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- AdventHealth (Glendale Heights, IL)
- …resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...physician advisor to avoid concurrent denials. + Collaborates with medical staff, nursing staff, payor, and ancillary staff to… more
- Trinity Health (Columbus, OH)
- …Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. + ... analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the...Coordinates with Medical Director /Associate Medical Directors on… more
- AmeriHealth Caritas (Washington, DC)
- …compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Baylor Scott & White Health (Dallas, TX)
- …and shares knowledge with healthcare staff. Works closely with Medical Director and Health Services leadership. Manages utilization and formulates policies. ... based on clinical information. Follow medical criteria and discuss with the Medical Director . Notify providers and members promptly. + Request medical … more
- Ascension Health (Pensacola, FL)
- … review programs and key performance indicators for all utilization review activities. + Interact with medical , nursing, and executive leadership to ... **Details** + **Department: Utilization Review ** + **Schedule: Full time...including management of patient statusing processes and monitoring of medical necessity review functions for assigned sites.… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - Pacific hours** **Monte ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more