- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …to promote quality improvement for the facility; this includes participation as a physician utilization management advisor. Participate in VISN 6 Hospital ... Summary The Durham VA Medical Center is recruiting for a full-time Physician (Hospitalist - Section Chief). Applicants must be currently working as a Hospitalist… more
- Randstad US (Boston, MA)
- …Center, Hospital, Insurance Company, Physician office) + Knowledge of Utilization Management regulations and standards + Experience with Medicare, Medicaid, ... Provide support to UM Care Managers to ensure provider and member customer satisfaction. + Process authorizations and...+ Referrals + Medical Billing + medical coding + utilization management + medicare/medicaid + Spanish Qualifications… more
- Beth Israel Lahey Health (Burlington, MA)
- …challenge physician practices to achieve the organization's desired resource management and quality goals. **Job Description:** Purpose: Provide leadership ... and expertise relative to the level of care management , concurrent and retro commercial payer validation of medical...allocation - Serves as physician expert and provide support to utilization review team regarding… more
- AdventHealth (Maitland, FL)
- …our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality ... On Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle...Care Management ..Serves as a member of the Utilization Management (UM) Committee by ensuring committee… more
- Kepro (AR)
- …being a vital partner for health solutions in the public sector. The Dental Physician Reviewer will oversee utilization / management (UM) activities to ... contract for Arkansas. + Responsible for the clinical oversight of the Dental Utilization Management program. + Collaborate with Medical Director on case… more
- WMCHealth (Valhalla, NY)
- …role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + Reviews ... on UM Committee .Provides Physician administrative support and leadership to the utilization and resource management areas of Integrated Case Management … more
- Dartmouth Health (Lebanon, NH)
- …Keene is seeking a Physician Advisor (PA) with expertise in Utilization Management , Care Management , and Clinical Documentation. The PA ... supports Utilization Management by performing concurrent, evidence-based second-level medical necessity reviews, educating physicians on medical necessity for… more
- Kepro (AR)
- …looking for a to join our growing team. Job Summary: The Dental Physician Reviewer-Orthodontist will oversee utilization review/ management activities to ... Dental Physician Reviewers on case consultations s needed. + Discuss complicated Utilization Management reviews or clinical scenarios with + Utilization … more
- Hackensack Meridian Health (Hackensack, NJ)
- …to support, and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management (UM) goals ... a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient… more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Nuvance Health (Rhinebeck, NY)
- …standards and monitoring systems for quality initiatives, patient care review, physician privileging, utilization review, risk management , infection ... a liaison, core faculty, and participant in recruitment and policy review. 3. * Management /Strategy* * Address physician and provider issues, including… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... the business processes and operations for all levels of utilization management review (ie, Precertification and Intake...Directors and/or business leads), plan medical staff and key provider - facility and physician or group… more
- SSM Health (Oklahoma City, OK)
- … leadership and physician coaching for all activities of care management , utilization management , and clinical documentation integrity. Collaborates with ... physician expert, providing medical direction and oversight to care management , utilization management andclinical documentation integrity (CDI)… more
- Stanford Health Care (Palo Alto, CA)
- …with the UM/CM Medical Director on strategic issues involving Utilization Management Department programs. + Collaborates with Physician Advisory Services to ... onsite Stanford Health Care job.** **A Brief Overview** The Dir- Utilization Management (UM) leads and shapes the...of services through UR, review of medical records and provider education, while identifying training opportunities and trends. +… more
- Trinity Health (Boise, ID)
- …Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and oversight of our Physician Advisor team and ... as assigned. D. Engage in physician -to- physician communication to provide just-in-time education and resolve conflicts regarding utilization concerns and… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- …Facilitates patient throughput with an ongoing focus on quality and efficiency. Provide Utilization Management consultations for the Emergency Department, ... Summary The Patient Flow Utilization Management / Utilization Review Consultant...Consultant RN functions with advanced knowledge and skills to provide clinical coordination and oversight for their patient population.… more