• Associate Medical Director

    Independent Health (Buffalo, NY)
    Director , Utilization Management is responsible for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will ... with focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the ...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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  • Medical Director of Utilization…

    Henry Ford Health System (Detroit, MI)
    …10. Lead IPAS - scheduling, reviews, feedback 11. Peer-to-peer cases a. Work with system UM medical director to streamline P2P cases b. Complete P2P for ... The Medical Director of Utilization Review is...The Medical Director of Utilization Review is responsible for the...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 - Oklahoma Medicaid

    CVS Health (Oklahoma City, OK)
    …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
    CVS Health (10/03/24)
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  • Case Managment /Care Coordination Director

    Nuvance Health (Norwalk, CT)
    …cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. ... in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care… more
    Nuvance Health (10/13/24)
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  • Director , Trial Attorney BI/ UM

    USAA (New Orleans, LA)
    …Come be a part of what makes us so special! **The Opportunity** As a dedicated Director , Trial Attorney (BI/ UM ) you will lead a team of Legal Assistants and ... their physical, financial, and emotional wellness. These benefits include comprehensive medical , dental and vision plans, 401(k), pension, life insurance, parental… more
    USAA (10/31/24)
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  • Dental UM Supervisor (Remote within…

    Kepro (AR)
    …supervision of the Program Director and in collaboration with the Clinical Director and Medical Director , the Team Supervisor oversees clinical staff ... the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing...continuous learning needs and, in collaboration with the Clinical Director and Program Director , develop and implement… more
    Kepro (10/31/24)
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  • Chair of Critical Care - UM Capital Region

    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
    University of Maryland, Baltimore (08/13/24)
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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 ... public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary:...+ Develop and complete an annual review of clinical medical necessity criteria. + Travel in-state as needed for… more
    Kepro (08/17/24)
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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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  • UM Coordinator - Utilization Review - F/T…

    Hackensack Meridian Health (Belle Mead, NJ)
    …concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points and attend ... or team meetings, collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of care. Referral of… more
    Hackensack Meridian Health (10/28/24)
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  • Manager, Clinical Pharmacist UM

    Healthfirst (NY)
    …**Duties and Responsibilities:** + Responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly reports ... medicine, and trends in medicine. + Work with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions Supervises, evaluates,… more
    Healthfirst (10/19/24)
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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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  • 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 health ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
    Commonwealth Care Alliance (09/19/24)
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  • Senior Manager, Medical Policy

    Healthfirst (NY)
    …and medical departments + Conducts ad hoc medical condition research per Medical Director and/or UM Clinical Director requests + Collaborates ... **Duties/Responsibilities:** + Develops, reviews, and updates medical policies and clinical guidelines to ensure they...input and ensure policies reflect the latest advancements in medical science and technology + Monitors changes in regulations,… more
    Healthfirst (10/31/24)
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  • Senior Medical Director - Sharp…

    Sharp HealthCare (San Diego, CA)
    …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...+ Achieves and maintains benchmarked utilization and cost management ( UM ) goals and clinical quality improvement (QI) objectives, in… more
    Sharp HealthCare (10/20/24)
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  • Utilization Management Admissions Liaison RN II…

    LA Care Health Plan (Los Angeles, CA)
    …setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
    LA Care Health Plan (10/23/24)
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  • Market Director Utilization Management

    Catholic Health Initiatives (Lexington, KY)
    …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central...and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s)… more
    Catholic Health Initiatives (09/19/24)
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  • Medical Director , Behavioral Health…

    Magellan Health Services (San Diego, CA)
    …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
    Magellan Health Services (10/27/24)
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  • Medical Director - New England…

    CVS Health (Hartford, CT)
    …Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Massachusetts or Maine. The Medical Director will be responsible for overseeing the utilization ... performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have...of the states in the New England Region *Previous UM experience with a Health Plan / Payor. *Previous… more
    CVS Health (10/03/24)
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  • Physician-Scientist, Director Of Clinical…

    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
    University of Maryland, Baltimore (10/16/24)
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