• Medical Director - Medical

    CVS Health (Sacramento, CA)
    …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds… more
    CVS Health (11/22/24)
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  • Associate Medical Director

    Independent Health (Buffalo, NY)
    …for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will support the development and maintenance of ... and commitment to diversity and inclusion. **Overview** The Associate Medical Director , Utilization Management is...efforts to develop strategic corporate direction / focus for UM programs. The AMD will support the SVP, Healthcare… more
    Independent Health (10/18/24)
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  • UM Coordinator - Utilization Review…

    Hackensack Meridian Health (Belle Mead, NJ)
    …and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at ... healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral health… more
    Hackensack Meridian Health (10/28/24)
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  • Supervisor, UM Coordinator

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …operations. The Supervisor of the UM Coordinator reports to the UM Manager and/or Director of Clinical Programs. Primary Responsibilities * Supervises ... to improve member and client satisfaction and business performance. * Works with UM Manager and/or Director to identify performance improvement initiatives and… more
    Brighton Health Plan Solutions, LLC (11/19/24)
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  • Managed Care Coordinator UM II

    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...extension) **Role Overview** This role involves reviewing and evaluating medical or behavioural eligibility for benefits and clinical criteria… more
    ManpowerGroup (10/30/24)
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  • Medical Director - Oklahoma Medicaid

    CVS Health (Oklahoma City, OK)
    …that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
    CVS Health (10/03/24)
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  • Care Review Processor- UM experience-PST…

    Molina Healthcare (CA)
    …from authorization requests or for additional information as requested by the Medical Director . + ** Utilization Management experience-Health plan or ... Experience** 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred. To all current Molina employees: If you are… more
    Molina Healthcare (11/13/24)
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  • Medical Director

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review...reviews, feedback 11. Peer-to-peer cases a. Work with system UM medical director to streamline P2P ... of hospital resources, and continued stays of inpatients. The Medical Director of utilization review...hours with team as needed 6. Work with central UM to ensure correct patient status (IP v OP)… more
    Henry Ford Health System (11/06/24)
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  • Medical Director

    AnMed Health (Anderson, SC)
    The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively...the leadership and staff who perform the functions of Utilization Management ( UM ), Case Management (CM), Transition… more
    AnMed Health (10/22/24)
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  • Utilization Management Director

    CareFirst (Baltimore, MD)
    …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... strategic business partners. This role encompasses six distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization… more
    CareFirst (11/26/24)
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  • Market Director of Utilization

    Ascension Health (Nashville, TN)
    …Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...optimize patient care, and partner with the National Senior Director of UM to align on organizational… more
    Ascension Health (10/25/24)
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  • Corporate Director of Clinical…

    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 the… more
    Prime Healthcare (08/29/24)
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  • Supervisor, Utilization Management RN

    LA Care Health Plan (Los Angeles, CA)
    …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
    LA Care Health Plan (11/06/24)
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  • Utilization Review Coord

    Covenant Health Inc. (Louisville, TN)
    …treatment and authorizes sessions per guidelines. + Works collaboratively with Medical Director and accesses consultation and involvement whenever appropriate ... targets. + Provides medical /psychiatric leadership/consultation to Provider Relations, Medical Utilization Management, and Quality Management Staff in… more
    Covenant Health Inc. (11/05/24)
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  • Utilization Management Nurse Specialist RN…

    LA Care Health Plan (Los Angeles, CA)
    …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... Utilization Management Nurse Specialist RN II Job Category:...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group… more
    LA Care Health Plan (11/09/24)
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  • Senior Medical Director - Sharp…

    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...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
    Sharp HealthCare (10/20/24)
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  • Appeals Manager, Department of Utilization

    BronxCare Health System (Bronx, NY)
    …activities and monitoring on a quarterly basis and reports findings/analysis to Director . - Conducts educational/feedback sessions with UM staff related to ... - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the...response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of… more
    BronxCare Health System (09/18/24)
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  • Clinical Director - Early Childhood Support…

    Magellan Health Services (Hodge, LA)
    The ECSS Clinical Director will have oversight and monitoring of ECSS site-developed assessments and Plans of Care to ensure the highest level of standards of care ... interventions based on data, including identifying and correcting over or under utilization of services. Train and monitor ECSS Sites to ensure compliance with… more
    Magellan Health Services (10/24/24)
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  • Behavioral Health Medical Director

    Kepro (Indianapolis, IN)
    …provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. The Medical Director will be responsible ... sector. Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team....clinical specialty if MD or DO. + Experience in Utilization Management ( UM ) with knowledge of Medicaid… more
    Kepro (11/26/24)
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  • Medical Director (Behavioral Health)…

    Magellan Health Services (Honolulu, HI)
    …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
    Magellan Health Services (09/25/24)
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