• Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
    LA Care Health Plan (03/02/24)
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  • Medical Director Aetna Duals Center…

    CVS Health (Columbus, OH)
    …urgent cases can be done from your laptop. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a medical director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
    CVS Health (03/19/24)
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  • Medical Director Aetna Duals Center…

    CVS Health (Springfield, IL)
    …with the schedule and open to discussion. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a Medical Director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
    CVS Health (05/08/24)
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  • Statewide Director of Nursing

    YesCare Corp (Hanover, MD)
    …Shares information gathered at the quarterly area multidisciplinary CQI Committee meetings with the Utilization Management Medical Director to be used at ... Nurse in Maryland. + Current Basic Life Support/CPR Certification at the Medical Professional Level with AED Training. American Heart Association is the preferred… more
    YesCare Corp (05/10/24)
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  • Medical Director , LTSS

    AmeriHealth Caritas (Newark, DE)
    …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the CMO. The following ... years of clinical practice experience. + Experience in Utilization Management as a Medical Director within a managed care organization preferred. +… more
    AmeriHealth Caritas (05/09/24)
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  • Medical Director Utilization

    Geisinger (Scranton, PA)
    management of the Utilization Review policy and observation management performance including outcomes of medical necessity justification with health plan ... Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of… more
    Geisinger (05/03/24)
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  • Medical Oncology Medical

    Elevance Health (Columbus, OH)
    **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign ... set of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director supporting our Medical Oncology team** is… more
    Elevance Health (05/02/24)
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  • Medical Director - Medical

    CVS Health (Springfield, IL)
    …support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization… more
    CVS Health (04/16/24)
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  • Medical Director - North Central…

    Humana (Columbus, OH)
    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 ...managed care experience working with LTSS program population. + Utilization management experience in a medical more
    Humana (04/25/24)
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  • RN Care Manager - SCO (Brockton Area - Bilingual…

    Point32Health (MA)
    …and liaises with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director , pharmacy, community health ... CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care,...ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works… more
    Point32Health (04/09/24)
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  • Medical Director - Florida

    Humana (Columbus, OH)
    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 (05/04/24)
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  • Medical Director - Southeast Region

    Humana (Columbus, OH)
    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 actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical more
    Humana (05/10/24)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    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 (04/12/24)
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  • Director Utilization

    Virginia Mason Franciscan Health (Bremerton, WA)
    …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...for medical staff on issues related to utilization management . 1. Implements utilization more
    Virginia Mason Franciscan Health (04/26/24)
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  • Medical Director : Documentation…

    Trinity Health (Boise, ID)
    …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is… more
    Trinity Health (04/16/24)
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  • Senior Director Utilization

    Providence (Seattle, WA)
    **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and ... and consistent with all PH&S policies and procedures. + Provides expertise in Utilization Management to Nursing and Medical Staff; Is viewed as a resource… more
    Providence (02/16/24)
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  • Director of Utilization

    Regis HR Group (Miami, FL)
    …trains and disciplines staff to ensure smooth operations in utilization management . + Also facilitates educational training for medical staff on issues ... Develops, manages and directs the Utilization Management programs for the primary... trends, patterns, and impact to appropriate departmental and medical staff committees. + Assures compliance with Federal, State,… more
    Regis HR Group (05/07/24)
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  • Director of Utilization

    Universal Health Services (Sacramento, CA)
    Responsibilities Sierra Vista Hospital is seeking a talented and dynamic Director of Utilization Management to join our team of dedicated healthcare ... inpatient alcohol detox and outpatient chemical dependency services. Position Summary: The Clinical Director of Utilization Management is responsible for the… more
    Universal Health Services (04/18/24)
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  • Corporate Director of Clinical…

    Prime Healthcare (Ontario, CA)
    …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
    Prime Healthcare (04/29/24)
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  • RN Director Utilization

    Ascension Health (Austin, TX)
    …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and...Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell… more
    Ascension Health (04/20/24)
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