- USAA (New Orleans, LA)
- …Come be a part of what makes us so special! **The Opportunity** As a dedicated Director , Trial Attorney (BI/ UM ) you will lead a team of Legal Assistants and ... Trial Attorneys that provide legal representation to defend USAA members, insured clients and USAA entities in all phases of civil litigation that result from covered property and casualty claim losses. The scope of work includes all litigation phases from the… more
- 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
- Catholic Health Initiatives (Lexington, KY)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... hospitals and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation,… 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
- 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
- Kepro (AR)
- …for health solutions in the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing team. Job Summary: + Under ... the general supervision of the Program Director and in collaboration with the Clinical ...the Team Supervisor oversees clinical staff performing Utilization Management ( UM ) and Reviews services for Medicaid Members in accordance… 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
- Kepro (AR)
- …health solutions in the public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary: The Dental Physician Reviewer-Oral ... applicable contract. The Oral Surgeon Physician Reviewer will support the dental UM contract for Arkansas Medicaid. Job Responsibilities: + Collaborate with Medical … 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
- 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
- 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
- University of Miami (Miami, FL)
- …training packets containing appropriate measures/forms + Other duties as assigned by the UM PCIT Director and team leaders + Assist with manuscript preparation ... at-risk for child maltreatment. + Scores program metric measures + Enters UM PCIT related data into appropriate databases/systems (eg, REDCap, etc.) + Provides… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... improving the quality of life and longevity of the citizens of Maryland. The UM -IHC, located in North Bethesda, MD, is a collaborative effort of the University of… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management ( UM ) functions for physical health ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
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