- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- CareFirst (Baltimore, MD)
- …Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the medical ... for network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the … more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for ... (UM) department across the Houston Methodist system. This position oversees all aspects of utilization review to ensure medical necessity, level of care… more
- Fallon Health (Worcester, MA)
- …the cost of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ...for hiring appropriate non-physician clinical and non-clinical personnel to review medical cases and determine if requests… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... required by law. Alternate locations may be considered. The ** Medical Director ** is responsible for reviewing cases...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Cleveland, OH)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Insight Global (New York, NY)
- …practice medicine is required. * 3+ years of clinical practice * 2+ years of utilization review experience in a managed care plan (health care industry) referred ... Job Description This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services...* Use correct templates for documenting decisions during case review . * Receive and review escalated reviews.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is...UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...management program, denials and appeals activities. Works with UR Director , UR Senior Director , and Payor Relations… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Houston Methodist (Katy, TX)
- … medical necessity, level of care, and payer requirements. Reporting to the Director of Centralized Utilization Review , the Centralized Manager, UR ... At Houston Methodist, the Manager Centralized Utilization Review (UR) position is responsible...+ Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... improvement in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance...Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart...all tasks requested by the UR Manager, CEO or Medical Director to meet the needs of… more