- 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
- 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
- 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
- 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …operations. The Supervisor of the UM Coordinator reports to the UM Manager and/or Director of Clinical Programs. Primary Responsibilities * Supervises ... and client satisfaction and business performance. * Works with UM Manager and/or Director to identify performance...or GED. * Team leadership experience required. * Strong medical record review skills. * Previous experience in quality… 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
- 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
- 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
- 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
- Molina Healthcare (CA)
- …from authorization requests or for additional information as requested by the Medical Director . + **Utilization Management experience-Health plan or IPA** + ... Experience** 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred. To all current Molina employees: If you are… more
- 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
- 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
- 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
- University of Michigan (Ann Arbor, MI)
- Executive Director of Facilities Planning and Operations, U-M Health Apply Now **How to Apply** A cover letter is required for consideration for this position and ... and experience that directly relate to this position. **Job Summary** The Executive Director of Facilities and Operations, U-M Health (Executive Director ) is an… more
- Magellan Health Services (Honolulu, HI)
- …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
- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team. Job Summary: The Part-Time ... Behavioral Health Medical Director shall provide the clinical and...if MD or DO. + Experience in Utilization Management ( UM ) with knowledge of Medicaid and Medicare programs. +… more
- 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
- 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
- Magellan Health Services (Hodge, LA)
- The ECSS Clinical Director will have oversight and monitoring of ECSS site-developed assessments and Plans of Care to ensure the highest level of standards of care ... in Louisiana, candidates must reside in Louisiana. Maintains accountability for medical management functions to achieve the business and clinical outcomes for… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Comprehensive Cancer Center (UMGCCC), located in Baltimore, MD are recruiting for a*full-time Medical Director of the University of Maryland St. Joseph Cancer ... Institute, located in Towson, MD.* *_Administrative duties and responsibilities of the Medical Director role will include, but not limited to the following:_* *… more
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