- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...of cost-effective health resources. Will be responsible for the Commercial , Federal Employee Program, Medicaid, and Medicare lines of… more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... disciplines to include discharge planning and referrals for case management . * Utilization management duties...appropriate health plan. Collaborates, coordinates with TOPA and Referral Management Director when needed in accordance with… more
- Abbott (Princeton, NJ)
- …projects and initiatives to maximize top-line and bottom-line results. The Commercial Director will apply efficient action-oriented and innovative ... people in more than 160 countries. **Supervisory Organization:** Global Commercial Operations **Position** : Global Director , ...deal coaching, etc. + CRM / SFDC and other commercial technology platforms and data management This… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- HCA Healthcare (Nashville, TN)
- …environment where diversity and inclusion thrive? Submit your application for our Director Purchased Services Commercial Products opening with HealthTrust today ... **_Note: Eligibility for benefits may vary by location._** We are seeking a Director Purchased Services Commercial Products for our team to ensure that… more
- Elevance Health (Chicago, IL)
- …will be supporting our clients in operations with utilization and case management reviews. In addition, the medical director will leverage oncology knowledge ... **Oncology Medical Director - Commercial National Division** Location: This...with support for cancer care case management , provider collaboration, and client facing activities as related… more
- Gilead Sciences, Inc. (Foster City, CA)
- …resources leader to join our team. This role will serve as **Senior Director ** , **Human Resources** **Business Partner** for our **Intercontinental (ICR) and Gilead ... and serve as a key member of the Gilead Commercial HR team on planning and delivering HR programs...to support growth. Drive organizational effectiveness and thoughtful change management . + **Strategic Advisor.** Serve as integrated part of… more
- CVS Health (Columbus, OH)
- …Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license in ... coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and clinical liaison to… more
- Huron Consulting Group (Chicago, IL)
- …They provide client engagement delivery oversight, team leadership and program management . Throughout the process, they construct enduring relationships that benefit ... leadership instill passion and followership in clients, juniors and management . If you're defined by ongoing progress-if you can...clients achieve their full potential. Rewarding and boundless a Director role at Huron will ignite your future in… 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 ... Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and… 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
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective review Process. Performs ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, site… 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 ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… 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
- LifePoint Health (Rutherfordton, NC)
- …and knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of ... and concurrent review. Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard… more
- Clean Harbors (Dallas, TX)
- Clean Harbors is looking for a ** Director of Fleet Asset Management ** to join our safety conscious team! The Director will provide leadership for the overall ... management of the Company's key asset classes. Lifecycle management responsibilities include asset acquisition and justification, asset deployment, designing 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 ... practice management . + Prefer Medical Oncology or Surgery specialties + Utilization management experience in a medical management review organization,… more
- Magellan Health Services (San Diego, CA)
- …appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management ... plan(s) for all lines of business (Medicaid, Medicare, and Commercial ) and implements programs to support this vision. May...plans. + Develops and implements a Utilization Management program and action plan, which includes strategies that… 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 ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… more
- HUB International (Wilmington, MA)
- …States, Canada and Puerto Rico. We currently have an opportunity for a ** Commercial Insurance Client Advisor - Management Liability Insurance (Potential for ... Specialty lines area. Ensures that HUB Way Marketing Workflows are captured through utilization of agency management system in accordance with HUB policies and… more