- 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) ... hospital resources, and continued stays of inpatients. The Medical Director of utilization review will...Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data,… more
- SUNY Upstate Medical University (Syracuse, NY)
- … Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director of Utilization ... and provides feedback/mentorship to UR CR I as to review , payor and regulatory questions. This UR DRU 3...nursing experience required. Minimum of 1 year of denial management experience with progressive proficiency and autonomy of reviews… more
- AdventHealth (Maitland, FL)
- …as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends ... review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning,… more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director , Finance, Utilization Review Department and CDCI. ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- BrightSpring Health Services (Canton, OH)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS & MGMT CONSULTANT II - SES - 65000379 (DEPUTY DIRECTOR OF OPPG) Date: Nov 15, 2024 The State Personnel System is an E-Verify employer. For more ... MGMT CONSULTANT II - SES - 65000379 (DEPUTY DIRECTOR OF OPPG) Pay Plan: SES Position Number: 65000379...Assist with workloads, workflows, deadlines, work objectives and time utilization with OPPG employees. + Review and… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …facility. This role includes direct involvement in patient care coordination, discharge planning, and utilization review . The Director will manage a team of ... The Director of Case Management is responsible...patient-centered care and advocate for patient rights and needs. Utilization Review and Compliance + Monitor and… more
- Elevance Health (Los Angeles, CA)
- …or equivalent. Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... more junior Clinicians. Approval decisions may be subject to review by more senior nurses or Medical Director...initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes.… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured… 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 ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... drugs. Sign-on bonus eligible FUNCTION: To provide comprehensive clinical case management services that include: assessments; individual, group and family treatment;… 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
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in ... /supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related area. +… more
- Michigan State University (East Lansing, MI)
- …within the unit + Work with the Associate Director in the continuous review of utilization of technology and the development of the team as professional ... on new program development as well as ongoing quality improvement of program management processes and procedures. The Assistant Director supports the creation… more
- Michigan State University (East Lansing, MI)
- …within the unit + Work with the Associate Director in the continuous review of utilization of technology and the development of the team as professional ... Initiative program development as well as ongoing quality improvement of program management processes and procedures. The Assistant Director supports the… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …treatment team, Director of Utilization Management , and the Medical Director . + Review charts at identified review points and attend treatment ... of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… 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
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