- Independent Health (Buffalo, NY)
- … Director , Utilization Management is responsible for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will ... with focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the ...efforts to develop strategic corporate direction / focus for UM programs. The AMD will support the SVP, Healthcare… more
- USAA (New Orleans, LA)
- …Come be a part of what makes us so special! **The Opportunity** As a dedicated Director , Trial Attorney (BI/ UM ) you will lead a team of Legal Assistants and ... their physical, financial, and emotional wellness. These benefits include comprehensive medical , dental and vision plans, 401(k), pension, life insurance, parental… more
- Kepro (AR)
- …supervision of the Program Director and in collaboration with the Clinical Director and Medical Director , the Team Supervisor oversees clinical staff ... the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing...plan, organize, and direct the work activity of the review team, consistent with organizational policies and procedures and… more
- Kepro (AR)
- … UM contract for Arkansas Medicaid. Job Responsibilities: + Collaborate with Medical Director and other Dental Physician Reviewers on case consultations as ... public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary:...Utilization Management reviews. + Develop and complete an annual review of clinical medical necessity criteria. +… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points ... medical necessity to Physician Advisor for determination. + Review clinical and diagnostic interventions for appropriateness and timeliness to achieve… more
- ManpowerGroup (Columbia, SC)
- …review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + Participate in ... + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required...their health, chronic or acute illnesses. **Key Responsibilities** + ** Medical or Behavioral Review & Authorization Process… more
- Healthfirst (NY)
- …Description **Duties and Responsibilities:** + Responsible for developing clinical criteria, medical policies for provider administered medications, review of ... medicine, and trends in medicine. + Work with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions Supervises,… more
- CVS Health (Sacramento, CA)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...as directed by the Quality Management + Committee, Peer Review Committee and Chief Medical Officer and… more
- Catholic Health Initiatives (Lexington, KY)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central...and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- CVS Health (Oklahoma City, OK)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director ...members and providers related to precertification, concurrent review , and appeal request. This position is primarily responsible… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... This is a part time position doing case review , remote work from home, and the work...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- CVS Health (Hartford, CT)
- …Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Massachusetts or Maine. The Medical Director will be responsible for overseeing the utilization ... would have experience performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a New England state… more
- AdventHealth (Maitland, FL)
- …prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims ... role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs,...with the other medical directors..Participates with the Medical Directorate to review and develop … more
- University of Maryland, Baltimore (Baltimore, MD)
- …Comprehensive Cancer Center (UMGCCC), located in Baltimore, MD are recruiting for a*full-time Medical Director of the University of Maryland St. Joseph Cancer ... in Towson, MD.* *_Administrative duties and responsibilities of the Medical Director role will include, but not...accord with institutional research processes * Conducts physician peer review activities as requested by medical staff… more
- Magellan Health Services (Albuquerque, NM)
- …Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... staff and physician advisors. Ensures adequate physician resources. Develops and manages medical director and physician advisor budgets, travel budgets, and… more
- CVS Health (Tallahassee, FL)
- …health care more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 ... Better Health of Florida primarily, and the Southeast Region (KY, LA and WV). This Medical Director will be a "Work from Home" position primarily supporting the… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- … medical necessity determinations are consistent with CMS published guidelines corporate medical review criteria, and medical policy guidelines\. + ... clinical metrics that produce actionable information in support of medical management and quality improvement initiatives\. + Direct and...review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on… more
- CVS Health (Harrisburg, PA)
- …preferably resides in PA/DE/WV and have a PA/WV/DE License without encumbrances. In the Medical Director role you will provide oversight for medical policy ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination… more
- CVS Health (Baton Rouge, LA)
- …Better Health of Louisiana is seeking a dedicated and experienced Behavioral Health Medical Director . The ideal candidate will be a board-certified psychiatrist ... in a medical specialty. The Behavioral Health Medical Director will ensure timely medical...behavioral health denials, including state fair hearings and external review organizations. * Review and resolution of… more