- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual 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… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- AnMed Health (Anderson, SC)
- …and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at AnMed. The Medical Director ensures the program and ... The Utilization Review Medical Director supports operations...the leadership and staff who perform the functions of Utilization Management (UM), Case Management … more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
- UCLA Health (Los Angeles, CA)
- …timely communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team to ensure ... Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality issue… more
- Commonwealth Care Alliance (Boston, MA)
- CCA-Auth & Utilization Mgmt Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization ... licensed in Massachusetts. . Required Experience (must have): * 3-5 years utilization management experience * 3+ years' experience working in a health plan,… more
- HonorHealth (Mesa, AZ)
- …hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management , Nursing, the Chief Medical Officer and ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for departmental assessment,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . ... transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral… more
- Independent Health (Buffalo, NY)
- …benefits and commitment to diversity and inclusion. **Overview** The Associate Medical Director , Utilization Management is responsible for assisting the ... Medical Director in the oversight of Utilization Management (UM) programs and will support the development and maintenance of these programs, with focus on… more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- 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 ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Sacramento, CA)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Columbus, OH)
- …. **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the care received by members ... community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests.... + Prefer Medical Oncology or Surgery specialties + Utilization management experience in a medical … more
- 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 ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Martin's Point Health Care (Portland, ME)
- …applicable managed care experience with progressively increasing responsibilities in medical director capacities, including utilization management and ... and executes on all aspects of the health plan's medical policy, clinical utilization management programs and clinical benefit determinations. This role works… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… 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" ... and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- CVS Health (Austin, TX)
- …other Medical Leadership, Pharmacy Director , clinical staff (including those in utilization management , care management , quality management ), and ... and is responsible for * Leadership and counsel for utilization management * Leadership and participation in...management performance and coordination with physical health care management . - Participation in HHS medical director … more