- Independent Health (Buffalo, NY)
- …Medical Director , Utilization Management is responsible for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will ... focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the Medical Director ...efforts to develop strategic corporate direction / focus for UM programs. The AMD will support the SVP, Healthcare… more
- CVS Health (Sacramento, CA)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …operations. The Supervisor of the UM Coordinator reports to the UM Manager and/or Director of Clinical Programs. Primary Responsibilities * Supervises ... to improve member and client satisfaction and business performance. * Works with UM Manager and/or Director to identify performance improvement initiatives and… more
- Ascension Health (Nashville, TN)
- …in utilization management to optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready to lead and ... Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- Henry Ford Health System (Detroit, MI)
- …10. Lead IPAS - scheduling, reviews, feedback 11. Peer-to-peer cases a. Work with system UM medical director to streamline P2P cases b. Complete P2P for those ... The Medical Director of Utilization Review is responsible for the...hours with team as needed 6. Work with central UM to ensure correct patient status (IP v OP)… more
- CVS Health (Oklahoma City, OK)
- …regional role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from Home" ... Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers… more
- Nuvance Health (Norwalk, CT)
- …utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. Develops ... utilization management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social Work Skills.… more
- University of Michigan (Ann Arbor, MI)
- …Credit Reporting Act. **Supervision Received** + Supervision is received from the Administrative Director or designee ** UM EEO / AA Statement** + The University ... students, as well as primary care services for eligible UM faculty and staff. UHS is actively seeing compassionate,...providing the highest quality care for students and other UM affiliated patients. We are eager to assist you… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management… more
- University of Miami (Coral Gables, FL)
- …concerns and/or issues as soon as they arise; this includes involving the Director , Business Operations Manager, and/or UM HR as required. + Supervises ... a member of the Lowe's leadership team, the Assistant Director for Learning, Engagement, & Technology (ADLET) directs one...other departmental units, both at the Lowe and across UM 's three campuses, to further the museum's mission, advance… more
- Dignity Health (Carmichael, CA)
- …Social Workers, Care Coordination Assistants, two (2) Care Coordination Managers and a UM Analyst. The Director 's responsibility includes, but is not limited to ... of Excellence in Perinatal Care Hip- and Knee- Replacement. **Responsibilities** ** Director of Care Coordination** **Sign On Bonus / Relocation Options Available**… more
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, as required, ... for medical necessity are issued under the direction of the Medical Director or designee.Assists with transfers, when necessary. + Demonstrates knowledge of… more
- Healthfirst (NY)
- …clinical and medical departments + Conducts ad hoc medical condition research per Medical Director and/or UM Clinical Director requests + Collaborates with ... the Regulatory, Compliance, Legal and Clinical departments to ensure deliverables adhere to local, state, federal, and Healthfirst-specific compliance and regulatory guidelines. + Identifies potential organizational risks and helps facilitate process… more
- ManpowerGroup (Columbia, SC)
- + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required for the first week, followed by remote work. + **Hours:** Monday-Friday, ... + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + Participate in data collection/input… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical Utilization ... 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 Inc… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review ... charts at identified review points and attend treatment planning conferences or team meetings, collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of care. Referral of cases with… more
- Healthfirst (NY)
- …and controls resources while delegating and monitoring workloads. + Assists Director of Specialty Pharmacy Programs with reviewing team performance. Implements and ... communication, teamwork, and empowerment to make informed decisions. + Assists Director of Specialty Pharmacy Programs in directing, training, and developing team… more
- Molina Healthcare (CA)
- …requests or for additional information as requested by the Medical Director . + **Utilization Management experience-Health plan or IPA** + **Work ... Schedule-Tuesday-Saturday or Sunday-Thursday** **Job Qualifications** **Required Education** HS Diploma or GED **Required Experience** 1-3 years' experience in an administrative support role in healthcare. **Preferred Education** Associate degree **Preferred… more