- Harbor Health Services, Inc. (Mattapan, MA)
- …high utilization cases and those upon request of utilization or finance department. Works with UM RNs and Senior Medical Director to deny claims when ... of care within a managed care environment. Additionally, the Director of UM ensures that collaborative relationships...EOHHS, CMS and other regulatory entities. Collaborates with Senior Medical Director to resolve complex medical… more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in ... develop strong collaborative and positive mutually supported relationships between the medical center and its physicians to improve clinical quality, resource… more
- CVS Health (Madison, WI)
- …Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses ... that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- Humana (Little Rock, AR)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Providence, RI)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... per month with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing… more
- University of Michigan (Ann Arbor, MI)
- …UMH-West, and Oakland County + Work in partnership with Head Orthopedic Team Physician for UM Athletics and Medical Director for UM Athletics to ... Associate Director , Sports Medicine Apply Now **Job Summary** Leadership of Sports Medicine at UM Health will be vested in a multi-disciplinary triad leadership… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- Dignity Health (Bakersfield, CA)
- …reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting ... Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your responsibilities include reviewing medical records,… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... Duties: Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical...continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members… more
- Integra Partners (Troy, MI)
- …& Oversight + Provide day-to-day clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM team. + Ensure consistent, ... clarity + Experience as a health plan medical director + Experience with DMEPOS UM programs, MLTC, Medicaid, or Medicare Advantage + Experience chairing or… 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 support ... Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a...workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in… more
- CVS Health (Springfield, IL)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Fallon Health (Worcester, MA)
- …of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation… more
- Wellpath (Freehold, NJ)
- …for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization review, ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... life and longevity of the citizens of Maryland. The UM -IHC, located in North Bethesda, MD, is a collaborative...of Maryland College Park, and the University of Maryland Medical System, funded with initial grants from the State… more
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