- Trinity Health (Boise, ID)
- …Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation , and Utilization ... Management programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively with and provide consultation to the… more
- ERP International (Nellis AFB, NV)
- …employing team building concepts in both multi -and inter-disciplinary setting to maintain medical and utilization management goals. Must be able to provide oral ... and present medical care practices for patterns; trends incidents of under-or over- utilization of resources incidental to providing medical care. * Acts as… more
- Sharp HealthCare (San Diego, CA)
- …venues.Escalate and refers cases for consultation with Medical Director as appropriate.Oversee preparation, delivery and documentation of non-coverage ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care… more
- Guthrie (Binghamton, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at ... healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral health… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of… more
- Independent Health (Buffalo, NY)
- …to determine medical necessity, and when necessary, will consult with the Associate Medical Director and/or Medical Director for all requests that ... Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: ( Medical necessity review for… more
- Sharp HealthCare (San Diego, CA)
- …Care Coordinator level of review.Appropriately identify claims for review by the Medical Director to include obtaining the appropriate medically necessary ... the eMD for and forward the claim with all applicable information to the Medical Director . + Quality and Productivity Performance Achieve 90% or greater… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a...for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for… more
- Hartford HealthCare (Torrington, CT)
- …Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry Patient ... Care Team to assure Utilization Review activities on a 17 bed Adult unit....promote the individualized care plan. * Maintains timely patient-centered documentation that reflect the patient and client systems' pertinent… more
- UPMC (Hanover, PA)
- **UPMC is hiring a Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and holiday ... a nonpatient-facing position. This Registered Nurse is responsible for completing medical necessity reviews utilizing Indicia and InterQual criteria for admitted… more
- Acacia Network (Bronx, NY)
- …care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing residential ... Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job...from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Collaborates with Care Management and… more
- The Cigna Group (Bloomfield, CT)
- …well as research and provide a written detailed clinical summary for the Plan Medical Director . + Determine whether additional pre service, appeal or grievance ... appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The...of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal… more
- Katmai (Usaf Academy, CO)
- …+ Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... for assuring the receipt of high quality, cost efficient medical outcomes for those enrollees identified as having the...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of … more
- BronxCare Health System (Bronx, NY)
- …Patient and Customer Service. - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the episode of ... order to prepare a response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of denial reason and course… more
- Magellan Health Services (San Diego, CA)
- …and implementing medical action plans. + Supports senior medical director in parity analyses and documentation . + Participates in committee work and ... quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various… more
- Magellan Health Services (Albuquerque, NM)
- …Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... staff and physician advisors. Ensures adequate physician resources. Develops and manages medical director and physician advisor budgets, travel budgets, and… more