- NorthBay Health (Fairfield, CA)
- …Health this Director provides oversight for all aspects of Care Management and Population Health which includes: Utilization Management, Utilization Review, ... Denial Management, and Social Services for the NorthBay Healthcare Group. This director will collaborate with Quality and Operations leadership to support key… more
- Magellan Health Services (Honolulu, HI)
- …utilization data. Strong verbal and written communications skills. General Job Information Title Director , Clinical Care ( UM /BH), HMSA, Licensed/Reside ... of a high quality team and effective transitions of care with the clinical care ...care standards in the participating provider network, vendors, UM staff, Health Guides, and for case managers. +… more
- Kepro (AR)
- …a vital partner for health solutions in the public sector. Acentra is looking for a Clinical Director to join our growing team. Job Summary: The Clinical ... deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements… more
- WellSense (Boston, MA)
- …Process + At the direction of the Senior Director of BH Clinical Programs, independently leads new BH UM program development and implementation, starting ... coordination and integration between UM and other clinical departments (eg Care Management, Pharmacy, and...of UM activities. + Notifies the Senior Director of BH Clinical Programs if department… more
- University of Maryland, Baltimore (Baltimore, MD)
- …**Organization:** **School of Medicine - Clinical Departments* **Title:** * UM Shore Medical Director * **Location:** *null* **Requisition ID:** *240001D5* ... rewarded for your hard work and dedication to patient care . The University of Maryland School of Medicine is...health center that combines medical education, biomedical research, patient care and community service. The School of Medicine is… more
- University of Maryland, Baltimore (Baltimore, MD)
- …School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), located just outside ... Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care . The Chair will be responsible for directing and supervising the care… more
- Apex Health Solutions (Houston, TX)
- Position Summary: Responsible for providing care management and utilization management services and support to improve health outcomes via a coordinated approach. ... The Care Manager works in collaboration and continuous partnership with...coverage determinations with the leadership of the BH medical director Identify members at risk for poor outcomes, or… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …**Education, Knowledge, Skills and Abilities Required:** + RN, BSN, or Bachelors degree in a clinical field with a health care focus + Minimum five years of ... communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director...clinical experience in a behavioral health care setting. + Excellent written and verbal communication skills.… more
- University of Maryland, Baltimore (Baltimore, MD)
- … clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale initiative focusing on computational ... to supervise and mentor staff and fellows within the UM -IHC, and may provide clinical service in...faculty and trainees. If the candidate will provide patient care through clinical responsibilities, a medical degree… more
- CVS Health (Columbus, OH)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to...the Department. **Required Qualifications** * Minimum of 5 years clinical experience in direct patient care . *… more
- LA Care Health Plan (Los Angeles, CA)
- …RN II is responsible for ensuring that delegates contracted to perform Utilization Management ( UM ) functions on behalf of LA Care (LAC) is in compliance with ... liaison between the Plan Partners and PPGs and LA Care Health Plan regarding UM issues. The...includes liasing with internal Behavioral Health units, the Medical Director of Behavioral Health, attendance at UM … more
- City and County of San Francisco (San Francisco, CA)
- …and California Advancing and Innovating Medi-Cal (CalAIM) and their impacts on clinical care + Collaborates with the Director of Managed Care and with ... its Managed Care division which oversees the Office of Coordinated Care (OCC), Utilization Management ( UM ), and Quality Management (QM). Additionally, BHS… more
- Healthfirst (NY)
- …and effectiveness. Develops and leads a team to drive optimization across the Clinical Operations Landscape (including UM , CM, behavioral health, pediatrics, and ... leader coaching. Metric types include compliance activities, CM and UM activities, clinical status outcomes, medical cost...+ Masters degree and/or BS, BA in a health care related field + Experience in medical care… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …medical necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director ... care about your success. The Utilization Management ( UM ) Director is responsible for the market(s)...need the following: + Bachelor's degree in Nursing, Health Care Administration oradvanced clinical degree. + Minimum… more
- Dignity Health (Bakersfield, CA)
- … management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health ... work within PST business hours.** **Position Summary:** The Medical Director of UM reports to the Chief...**Qualifications** **Minimum Qualifications:** - Minimum of 10 years of clinical experience in a HMO/Managed Care setting;… more
- Catholic Health Services (Rockville Centre, NY)
- …and reporting physician and hospital outcomes. Educates members of the patient care team regarding clinical documentation and regulatory coding updates. Duties ... and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of- clinical -utilization-management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Magellan Health Services (Dallas, TX)
- …/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care . Provides ... quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality...care during this period at multiple levels of care . Clinical experience pertinent to the patient… more
- University of Maryland, Baltimore (Baltimore, MD)
- …care decision making * In collaboration with Oncology Practice Leadership and UM SJMC Leadership teams, develop annual clinical operational goals and ... located in Baltimore, MD are recruiting for a*full-time Medical Director of the University of Maryland St. Joseph Cancer...interventions in alignment with Oncology Clinical Service Line roadmap. * Attend UM … more
- CVS Health (Little Rock, AR)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a ... Projects and Committee participation when needed. + The Medical Director will provide clinical , coding, and reimbursement...*Two (2) or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
