- Humana (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
- Humana (Columbus, OH)
- …Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the care received by members in an assigned ... community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests.... + Prefer Medical Oncology or Surgery specialties + Utilization management experience in a medical … more
- Alameda Health System (Oakland, CA)
- …reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of patient ... Director in Establishing, implementing, and ensuring that care management policies, practices and procedures are...and assumes responsibility for day to day operations of utilization management , care coordination and… more
- Alameda Health System (Oakland, CA)
- …reports to appropriate committees and in conjunction with the Director of Care Management identifies utilization issues affecting the quality of patient ... classification. -Assists Director in Establishing, implementing, and ensuring that care management policies, practices and procedures are in accordance with… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care . + Knowledge of medical-necessity… more
- Ascension Health (Nashville, TN)
- …efficiency, lead strategic initiatives in utilization management to optimize patient care , and partner with the National Senior Director of UM to align ... throughout the TN market. We're looking for an experienced Director of Utilization Management to...analysis to enhance our processes. You'll collaborate with Market Care Management , Finance, CDI, and Physician Advisors… more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This...MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position… more
- AnMed Health (Anderson, SC)
- …direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at AnMed. The Medical Director ensures the program and ... The Utilization Review Medical Director supports operations...the leadership and staff who perform the functions of Utilization Management (UM), Case Management … more
- Henry Ford Health System (Detroit, MI)
- …DNB numbers 2. Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data, observation LOS b. ... The Medical Director of Utilization Review is responsible...updates, and LOS initiatives 13. Ensure compliance with CMS Utilization Management Conditions of Participation (COP) 14.… more
- 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: +… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual 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… more
- VNS Health (Manhattan, NY)
- …health organization (BHO), with minimum of 4 years in a BH utilization and care management Director or above leadership role within a managed care ... subcommittees such as Compliance and Pharmacy. + Develops, implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral… more
- Stanford Health Care (Palo Alto, CA)
- …leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships, ... Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs. + Assists Director ...+ Knowledge of principles and best practices of case management , utilization review, social work, care… 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
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in ... objectives. **Reporting Relationship:** Reports to and is evaluated by the Director , Care Management . **Supervisory Responsibilities:** In collaboration… more
- ERP International (Nellis AFB, NV)
- …direct patient care clinical inpatient and outpatient setting. Must have utilization management experience for 2 years in recent consecutive months including ... No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality… more
- Sharp HealthCare (San Diego, CA)
- …experience or case management experience + 3 Years recent case management , utilization review, care coordination experience + California Registered ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- HCA Healthcare (Campbell, CA)
- …midpoint of the range. **Introduction** Do you have the career opportunities as a(an) ** Utilization Management RN** you want with your current employer? We have ... of colleagues. Do you want to work as a(an) Utilization Management RN where your passion for...Minimum three to five years of experience in Managed Care , Provider Office, or Utilization Review organization… more
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