- VitalCore Health Strategies (Hopkinton, MA)
- …supervisory services are rendered. Must satisfy all credentialing requirements of VitalCore. Utilization Management experience. Must have minimum of 5 years ... clinical quality indicators, patient safety chart and site audits. Adherence to Utilization Management (UM) programs specific to the contract requirements and… more
- VitalCore Health Strategies (Munising, MI)
- …clinical quality and integrity of patient medical care including oversight of utilization and quality management , credentialing, and best practice guideline ... (VCHS), an industry leader in correctional healthcare, has an opening for a Hub Director - Upper Regional Medical Director - Upper Peninsula , Michigan! The HUB … more
- Fresenius Medical Care (Mayfield, KY)
- …As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. We believe our employees are our most important asset - we ... auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials… more
- Fresenius Medical Care (Mayfield, KY)
- …a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important ... auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials… 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
- 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
- Houston Methodist (Houston, TX)
- …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is ... At Houston Methodist, the Sr Director Case Management position is responsible...initiatives. + Provides strategic vision and execution for case management and utilization review across… more
- Wellpath (Freehold, NJ)
- …care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- Humana (Juneau, AK)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director -Care Management Are you exceedingly driven, dedicated, and passionate about caring for your patients? Do you consistently create and nurture… more
- Elevance Health (Las Vegas, NV)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… 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
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... will include every weekend (Saturday and Sunday). The **Medical Management Nurse** will be responsible for review ...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… more
- 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
- 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
- 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
- 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
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