- MEDSTAR HEALTH (Washington, DC)
- …referrals to Case Management as needed.Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications, ... for evaluating the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities. Responsible for clinical review of acute care… more
- AHU Technologies, Inc. (Washington, DC)
- …to assess and/or facilitate/assist them in the licensing process. *Performs effective utilization of the Microsoft Office Suite for tasks such as data entry ... than basic skills on use of excel. *Will work closely with the Sales Coordinators, Director of Sales, Director of Regulation & Oversight and other OLG executives… more
- MEDSTAR HEALTH (Clinton, MD)
- General Summary of PositionMedStar Southern Maryland is in search of a Director of Nursing for the Emergency Department. This position will be full time with varying ... the highest quality clinical care with advanced technology, innovative medical services, and the region's top doctors. Our hospital...improve the quality of life in our community. The Director of Nursing is a member of MedStar Health… more
- Defense Threat Reduction Agency (Fort Belvoir, VA)
- Summary This position serves as the Director , Human Resources Directorate, serving as the principal and key advisor. Duties Help As a SUPERVISORY HUMAN RESOURCES ... Serves as the principal and key advisor to the Director of DTRA and the senior leadership team on...that are responsive to the needs of both DTRA management and employees, and assures optimum productivity and goal… more
- MEDSTAR HEALTH (Laurel, MD)
- …times receive functional supervision from the VP Director , AVP Clinical Operations, and Medical Director . Must maintain a weight not to exceed 250 pounds in ... General Summary of PositionProvides comprehensive emergency medical care to the critically ill and injured...to: insertion of nasal and oral gastric tubes and management of autologous blood transfusion systems. Initiates and maintains… more
- Elevance Health (Ashburn, VA)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
- Evolent (Washington, DC)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- AmeriHealth Caritas (Washington, DC)
- …Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient ... policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer...and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical… more
- Cognizant (Washington, DC)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years'… more
- Elevance Health (Washington, DC)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Evolent (Washington, DC)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Evolent (Washington, DC)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Washington, DC)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Humana (Washington, DC)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Elevance Health (Washington, DC)
- …or healthcare leadership preferred. + Experience advising medical cost management , utilization management , payment integrity, or provider performance ... **Manager, Medical Director - Transformation Initiatives** Location:...+ **Cost of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM)… more
- Evolent (Washington, DC)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Evolent (Washington, DC)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be...Surgery you will be a key member of the utilization management team. We can offer you… more
