- CVS Health (Springfield, IL)
- …to 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… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Director of Utilization Management ( UM ) Cost of Care Strategy provides data-based ... for business segments or the company at large. The Director of Utilization Management ( UM )...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Evolent Health (Columbus, OH)
- …for the culture. **What You'll Be Doing:** **Value Proposition Statement:** As a Director , Utilization Management, you'll work with your managers, front line ... and efficiencies for our members, providers, and customers. **Collaboration Opportunities:** The Director , Utilization Management, will partner with a variety of… more
- AmeriHealth Caritas (Orlando, FL)
- ** Medical Director , UM Review,...initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization ... to practice in any state licensed in as a medical director . Additional state licensure required in...within 3 months of employment. 5+ yrs clinical practice. UM /Care Coordination exp. preferred. Your career starts now. We… more
- Elevance Health (Atlanta, GA)
- …within 50 miles of one of our Elevance Health office locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...or regulation, must be located in Georgia when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Nashville, TN)
- …must live within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Las Vegas, NV)
- …to Medicaid plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… 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
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the ... necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops… 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
- 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
- Guthrie (Binghamton, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves ... LPN - Utilization Management (Days) Full Time Position Summary: The Utilization Management ( UM ) Reviewer, in collaboration with other internal and external… more
- Intermountain Health (Las Vegas, NV)
- …and education for peer-to-peer reviews, prior authorization reviews, and other education within UM as determined by UM Medical and Operational Leadership. ... Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director...Job Profile: + Trains and educates on medical review activities pertaining to utilization review,… more
- YesCare Corp (Bartow, FL)
- … UM + Reviews requests for outpatient services, codes, and forwards to Corporate UM Medical Director + Performs monthly audit of Inpatient, ER and ... + Minimum of two (2) years prior experience with UM preferred + Minimum of one (1) year prior...report is sent to each site and participates in Utilization Review with Clinical Director and other… more
- Huron Consulting Group (Chicago, IL)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate utilization … more
- Trinity Health (Darby, PA)
- …Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with the RN ... Care Coordination Manager, provides support to the utilization management, denials and appeals process for the THMA...are met + Collaborates with Physician Advisor to clarify medical necessity or clinical rationale + Assists in corresponding… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes 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 (Los Angeles, CA)
- …net required to achieve that purpose. Job Summary Under the general direction of the Director of Utilization Management ( UM ) the Program Manager II is ... Utilization Management Program Manager II Job Category: Clinical...leading and managing a portfolio of strategic and transformational UM programs and projects that are generally complex and… more
- Billings Clinic (Billings, MT)
- …UM representatives on denials and coordinate peer to peer review with payer's medical director *Initiates and coordinates peer to peer reviews on all ... to all permanent full-time employees (minimum of 24 hours/week), including Medical , Dental, Vision, 403(b) Retirement Plan with employer matching, Defined… more
- City and County of San Francisco (San Francisco, CA)
- …specifically in the Mental Health Service Center + Supervises medical staff, including UM Medical Director , OCC Nurse Practitioner, and the medical ... including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective... Director of Managed Care and with OCC, Utilization Management ( UM ), and Quality Management (QM)… more
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