- Dignity Health (Bakersfield, CA)
- …and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- 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
- UPMC (Pittsburgh, PA)
- …UMPC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... and full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including… 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
- LifeCenter Northwest (Bellevue, WA)
- …- $199,200.00 Salary Position Type Full Time Description and Qualifications The Director , Organ Utilization ( Director ), is responsible for overseeing ... of organ donation systems, allocation practices, and regulatory compliance. The Director develops and executes strategies to improve organ allocation strategy and… more
- Wellpath (Lemoyne, PA)
- …**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
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work...and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... 401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - Compressed weekend night shift Friday - Sunday **Webster, Texas, United States** **New** Nursing & Care ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- CVS Health (Columbus, OH)
- …including phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. ... the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital… more
Related Job Searches:
Director,
Director Utilization,
Director Utilization Review,
Management,
Review,
Utilization,
Utilization Review