• 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 (08/23/24)
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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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  • Oral Surgeon ( UM Reviewer)

    Kepro (AR)
    UM contract for Arkansas Medicaid. Job Responsibilities: + Collaborate with Medical Director and other Dental Physician Reviewers on case consultations as ... health solutions in the public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary: The Dental Physician Reviewer-Oral… more
    Kepro (08/17/24)
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  • Dental UM Supervisor (Remote within…

    Kepro (AR)
    Medical Director , the Team Supervisor oversees clinical staff performing Utilization Management ( UM ) and Reviews services for Medicaid Members in ... the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing...Summary: + Under the general supervision of the Program Director and in collaboration with the Clinical Director more
    Kepro (10/31/24)
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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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  • Director , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management ( UM ) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic… more
    Commonwealth Care Alliance (09/19/24)
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  • Market Director Utilization

    Catholic Health Initiatives (Lexington, KY)
    …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s) ... necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops… more
    Catholic Health Initiatives (09/19/24)
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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 (08/27/24)
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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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  • LPN Utilization Mgmt Reviewer

    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
    Guthrie (09/11/24)
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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 Admissions Liaison…

    LA Care Health Plan (Los Angeles, CA)
    …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
    LA Care Health Plan (10/23/24)
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  • Manager II Behavioral Health Services…

    Elevance Health (FL)
    …analysis services. + Responsibilities include overseeing clinical rounds, coordinating with medical director to ensure program meets quality standards and ... Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization Management (BH UM ). Serves as a...make an impact:** + Serves as a resource for medical management programs. + Identifies and recommends revisions to… more
    Elevance Health (11/02/24)
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  • Utilization Review RN

    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 ... package to all full-time employees (minimum of 24 hours/week), including Medical , Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution… more
    Billings Clinic (11/05/24)
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