- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application of ... clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities...OIG sanctions + 5+ years of utilization management experience, including complex case review +… more
- Fallon Health (Worcester, MA)
- … to identify and prioritize the cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director to set agenda related to UM ... strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care,… 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...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… 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 ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director ...or past OIG or state sanctions + Experience performing utilization management or clinical review ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… 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 ... state or territory of the United States when conducting utilization review or an appeals consideration and...and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license… 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 ... ready to make a difference, join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is responsible for the design,… more
- Wellpath (Cleveland, OH)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… 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 ... leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. Primary Duties and...3+ years of clinical practice * 2+ years of utilization review experience in a managed care… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to… more
- Huron Consulting Group (Chicago, IL)
- … Utilization Review Plan and the overall operation of the Utilization Management Department in accordance with federal, state and local guidelines, ... hospital contractual payor agreements. This position reports to the Director of Utilization Management and...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - M-F, 8:00 AM - 5:00 PM **Webster, Texas, United States** Nursing & Care Management UTMB Health ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and ... secure timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities,… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
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