- Luminis Health (Lanham, MD)
- …operational throughout process in collaboration wth other unit leaders, Administrative Coordinator, Care Management , other nursing unit and support services to ... Job Code: 000747 FLSA Status: Non - Exempt Reports To : Clinical Director - Nursing Position Objective The Clinical Supervisor directly supervises staff and is… more
- Luminis Health (Lanham, MD)
- …operational throughout process in collaboration wth other unit leaders, Administrative Coordinator, Care Management , other nursing unit and support services to ... Job Code: 000747 FLSA Status: Non - Exempt Reports To : Clinical Director - Nursing Position Objective The Clinical Supervisor directly supervises staff and is… more
- Humana (Washington, DC)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... value-based care across the healthcare system. **Responsibilities** : 1. ** Utilization Management ** - Develop and lead a system-wide utilization… more
- Fallon Health (Worcester, MA)
- …+ Works with VP/Medical Director to identify and prioritize the cost of care opportunities related to Utilization Management . + Works with VP/ Medical ... With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer...responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care… more
- Mount Sinai Health System (New York, NY)
- … (Licensed)** is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and value-based care populations. This role drives ... Occupational Therapy **Experience Requirements** + 7+ years of experience in care management , utilization management , population health, or value-based… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care . **DUTIES… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Prime Healthcare (Inglewood, CA)
- …Social Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure ... part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our...patients receive timely, appropriate, and efficient care throughout their hospital stay. The Director … more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Health Services ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management...for assuring members receive high quality and appropriate clinical care in a timely and cost-effective manner. This role… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... Internal Medicine, and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license or the ability… more
- Integra Partners (Troy, MI)
- … (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… more
- Wellpath (Cleveland, OH)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …Collaborate closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and ... on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner + Ensure UM operations...improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for… more
- Insight Global (New York, NY)
- …turn-around times for clinical reviews. * Collaborate with other departments on Utilization Management Operations. * Lead key projects and drive initiatives ... 3+ years of clinical practice * 2+ years of utilization review experience in a managed care ...* Licensure in multiple Oscar states * Experience with care management within the health insurance industry.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the ... physicians for peer-to-peer case discussion. + Provides clinical support for utilization review, care management and quality to determine the medical… more
- LA Care Health Plan (Los Angeles, CA)
- …skills. Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). ... Utilization Management Nurse Specialist RN II...$115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created… more
- CommonSpirit Health (Phoenix, AZ)
- …ensuring the organization remains at the forefront of industry best practices in utilization management and patient care . **Essential Key Responsibilities:** ... **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of...and insurance representatives to resolve issues related to coverage, care management , and treatment options. Act as… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of federal,… more
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