- 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
- Point32Health (MA)
- …well as any partner entities at the direction of Behavioral Health Lead Medical Director for Utilization Management ( UM ) and/or the Medical ... member-facing initial reviews and appeals. They will work closely with colleagues in UM and Medical Management, and with other departments as needed, including… more
- Apex Health Solutions (Houston, TX)
- …coordinate pending cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans ... and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM...questionable admissions, and prolonged lengths of stays to the Medical Director for determination. Collect accurate data… more
- CVS Health (Baton Rouge, LA)
- …that primarily supports the Aetna Better Health Plan of Louisiana. 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
- 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
- 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
- Ascension Health (Nashville, TN)
- …the TN market. Must be located within TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, ... **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
- 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
- Independent Health (Buffalo, NY)
- …well as manage medical expenses based on trends. They will maintain UM review requirements, obtain reporting to understand utilization trends and cost, ... work through the process of obtaining approval for any changes from the Medical Director and governing committee(s) then overseeing the implementation throughout… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- 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
- Virginia Mason Franciscan Health (Bremerton, WA)
- …find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget ... eligibility, and more! **Responsibilities** **JOB SUMMARY/PURPOSE** Provides leadership to Utilization Management RNs, Denials RNs and support staff to accomplish… 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...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …TITLE: Utilization Review Clinician PAY RANGE: $31.00-$49.24 PER HOUR REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as member of ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training… more
- CVS Health (Phoenix, AZ)
- …Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Position requires proficiency with ... in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- 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
- Point32Health (MA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Medical Director , Clinical reviews will primarily perform utilization management and ... as any partner entities at the direction of the Medical Director for Utilization Management....will work closely with staff from all partners of UM ( Utilization Management), Medical Management… more
- 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
- Magellan Health Services (San Diego, CA)
- …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
- Molina Healthcare (CA)
- …information from authorization requests or for additional information as requested by the Medical Director . Must have: Medical terminology **ICD 10 code ... knowledge** **CPT code knowledge** **IPA or health plan UM experience(Prior authorization or Inpatient)** **Job Qualifications** **Required Education** HS Diploma or… more
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