• CHRISTUS Health (Tyler, TX)
    …of teams; identifying and addressing staff training and development needs Apprising medical staff, department heads, and administrators in matters related to nursing ... to set a baseline for comparison Discovers opportunities to improve resource utilization Implements changes in role consistent with scope of practice Anticipates and… more
    JobGet (11/08/24)
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  • CHRISTUS Health (Tenneryville, TX)
    …and teams; identifying and addressing staff training and development needs * Medical staff, department heads, and administrators in matters related to nursing ... to set a baseline for comparison . Discovers opportunities to improve resource utilization . Implements changes in role consistent with scope of practice .… more
    JobGet (11/01/24)
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  • CHRISTUS Health (Corpus Christi, TX)
    …high-quality, cost-effective care to patients. Responsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes ... Christi Bay is the largest and foremost acute care medical facility in the region, with a full range...scope of labor laws. Discovers opportunities to improve resource utilization . Implements changes in role consistent with scope of… more
    JobGet (11/03/24)
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  • Medical Director

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... utilization of hospital resources, and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient use of… more
    Henry Ford Health System (11/06/24)
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  • Medical Director : Documentation…

    Trinity Health (Boise, ID)
    …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead… more
    Trinity Health (10/14/24)
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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 with and provide consultation to the leadership and… more
    AnMed Health (10/22/24)
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  • Utilization Management & Quality Review…

    UCLA Health (Los Angeles, CA)
    …that clear, timely communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team to ... Description As the Utilization Management & Quality Review Specialist, you will...issue cases, ensuring compliance with regulatory requirements for both utilization management and quality assurance processes + Ensuring that… more
    UCLA Health (10/31/24)
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  • Director - Utilization and Denials…

    WellSpan Health (York, PA)
    …Committees. Co-chair's System Utilization Management Committee. + Works closely with Medical Director to identify trends in payor denials and appeals. + ... Joint Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings.… more
    WellSpan Health (10/08/24)
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  • Associate Medical Director - UM PT

    Independent Health (Buffalo, NY)
    …perks, benefits and commitment to diversity and inclusion. **Overview** The Associate Medical Director , Utilization Management is responsible for assisting ... the Medical Director in the oversight of Utilization Management (UM) programs and will support the development and maintenance of these programs, with focus… more
    Independent Health (10/18/24)
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  • Medical Director - Medical

    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 ... to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and… more
    CVS Health (08/23/24)
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  • Medical Director - South Central

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
    Humana (11/08/24)
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  • Medical Director - National Medicare…

    Humana (Columbus, OH)
    …quality management or utilization management. **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts ... caring community and help us put health first** The Medical Director relies on medical ...other healthcare providers, clinical group practice management. + Prefer Medical Oncology or Surgery specialties + Utilization more
    Humana (11/08/24)
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  • Medical Director - Acute Rehab Team

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...Integrated Delivery Systems, health insurance, other healthcare providers. + Utilization management experience in a medical management… more
    Humana (11/05/24)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
    Humana (10/29/24)
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  • Medical Director - Health Plan

    Martin's Point Health Care (Portland, ME)
    …including applicable managed care experience with progressively increasing responsibilities in medical director capacities, including utilization management ... to Work" since 2015. Position Summary The Health Plan Medical Director provides leadership for the clinical...and executes on all aspects of the health plan's medical policy, clinical utilization management programs and… more
    Martin's Point Health Care (09/19/24)
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  • Utilization Management Admissions Liaison…

    LA Care Health Plan (Los Angeles, CA)
    …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II (After Hours...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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  • Medical Director - Oklahoma Medicaid

    CVS Health (Oklahoma City, OK)
    …regional role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" ... health care more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6… more
    CVS Health (10/03/24)
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  • Surgical Review Specialist, Full-time(Remote)

    St. Luke's University Health Network (Allentown, PA)
    …incorrect registrations and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director , Finance, Utilization Review Department and ... lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical cases with potential status issues,… more
    St. Luke's University Health Network (10/31/24)
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  • Care Manager - Temporary

    InnovaCare (San Juan, PR)
    …process as required to meet member's needs.15. Performs authorizations determined by Medical Director , coordination, and utilization of the cases ... Participates in round clinics discussion with Multidisciplinary team such as program medical director as well as other disciplines, documenting all… more
    InnovaCare (10/16/24)
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  • Market Director Utilization

    Catholic Health Initiatives (Lexington, KY)
    …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development, ... root causes related to physician performance and facilitates educational training for medical staff on issues related to utilization management. 8. Implements… more
    Catholic Health Initiatives (09/19/24)
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