• Medical Director of Utilization

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... of hospital resources, and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient use of the institution's… more
    Henry Ford Health System (11/06/24)
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  • Market Director of Utilization

    Ascension Health (Nashville, TN)
    …Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready… more
    Ascension Health (10/25/24)
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  • Corporate Director of Clinical…

    Prime Healthcare (Ontario, CA)
    …Responsibilities The Corporate Director of Clinical ... 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 Management… more
    Prime Healthcare (08/29/24)
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  • Medical Director : Documentation…

    Trinity Health (Boise, ID)
    …Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead… more
    Trinity Health (10/14/24)
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  • Medical Director - Utilization

    AnMed Health (Anderson, SC)
    The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
    AnMed Health (10/22/24)
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  • Director , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    CCA-Auth & Utilization Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and ... quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management and care… more
    Commonwealth Care Alliance (11/26/24)
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  • Director of Case Management…

    Scottish Rite for Children (Dallas, TX)
    …priority! We're committed to giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - ... Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention + Transition… more
    Scottish Rite for Children (11/11/24)
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  • RN Registered Nurse Director

    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: + Ensure… more
    Ascension Health (11/21/24)
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  • Utilization Management & Quality Review…

    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 that all ... Description As the Utilization Management & Quality Review Specialist, you will...issue cases, ensuring compliance with regulatory requirements for both utilization management and quality assurance processes + Ensuring that… more
    UCLA Health (10/31/24)
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  • UM Coordinator - Utilization Review - F/T…

    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 . + ... and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of...ACCESS center staff and PFS department to ensure appropriate utilization of resources and benefits on a case by… more
    Hackensack Meridian Health (10/28/24)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    CCA-Auth & Utilization Mgmt Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization Management * ... is licensed in Massachusetts. . Required Experience (must have): * 3-5 years utilization management experience * 3+ years' experience working in a health plan,… more
    Commonwealth Care Alliance (11/26/24)
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  • Utilization Review Denials Review Unit 3…

    SUNY Upstate Medical University (Syracuse, NY)
    …This Utilization Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of Utilization ... Review with daily staff mentoring, leadership and resource provision. This position will have supervisory oversight of the DRU level I & II nurses and provides feedback/mentorship to UR CR I as to review, payor and regulatory questions. This UR DRU 3 Team… more
    SUNY Upstate Medical University (11/04/24)
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  • Executive Medical Director Revenue Cycle

    AdventHealth (Maitland, FL)
    …Medical Director is responsible for providing physician review of utilization , claims management, and quality assurance related to inpatient care, outpatient ... by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management..Reviews data and trends to identify… more
    AdventHealth (11/04/24)
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  • Utilization Review Clinician (Non-Remote)…

    Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
    POSITION TITLE: Utilization Review Clinician REPORTS TO (TITLE): Director of Utilization Review DESCRIPTION OF POSITION: Work as member of multi-disciplinary ... third party payers. + Recordkeeping: Maintains appropriate records of the Utilization Review Department. + Training: Provide staff in-service training and education.… more
    Sacramento Behavioral Healthcare Hospital (11/13/24)
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  • Director Case Management

    HonorHealth (Mesa, AZ)
    …hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management, Nursing, the Chief Medical Officer and the AVP ... more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for departmental assessment, problem… more
    HonorHealth (11/16/24)
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  • Associate Medical Director - UM PT

    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...focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the Medical Director more
    Independent Health (10/18/24)
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  • Organ Utilization Administrative…

    LifeCenter Northwest (Bellevue, WA)
    Utilization Administrative Coordinator is responsible for supporting the Organ Utilization Director and the department's Managers along with administrative ... management and meeting support - Manage the calendar of the Director of Organ Utilization and scheduling for the leadership team, scheduling meetings, booking… more
    LifeCenter Northwest (09/07/24)
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  • Medical Director - Medical Affairs…

    CVS Health (Sacramento, CA)
    …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) ... Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals)… more
    CVS Health (11/22/24)
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  • Medical Director - South Central

    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 an ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
    Humana (11/08/24)
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  • Medical Director - National Medicare Team

    Humana (Columbus, OH)
    …or utilization management. **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the ... of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The… more
    Humana (11/08/24)
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