- 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
- 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
- CVS Health (Sacramento, CA)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM...inter-rater review activities and other quality oversight processes for internal Director UM decisions. If… 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 ... Officer. **Required Qualifications** + Doctor of Medicine (MD) - Internal Medicine or Family Practice + **OR** Doctor of...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… 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
- 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 ... in Towson, MD.* *_Administrative duties and responsibilities of the Medical Director role will include, but not...be board certified or board-eligible by the ABIM in Internal Medicine and Hematology and/or Medical Oncology… more
- CVS Health (Columbus, OH)
- …Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...UM (Utilization Management) experience *Active and current state medical license in CA without encumbrances and willing to… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization,… more
- CVS Health (Raleigh, NC)
- …a North Carolina medical license or be willing to obtain one. In the Medical Director role you will provide oversight for medical policy implementation. ... staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review /… more
- Magellan Health Services (Albuquerque, NM)
- …Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... staff and physician advisors. Ensures adequate physician resources. Develops and manages medical director and physician advisor budgets, travel budgets, and… more
- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- VNS Health (Manhattan, NY)
- …other evaluative measures to maintain high-quality care standards. + Plans leadership and medical director meetings as stipulated by the State BH contract ... company holidays + Health insurance plan for you and your loved ones, Medical , Dental, Vision, Life and Disability + Employer-matched retirement saving funds +… more
- Healthfirst (NY)
- …and business leader coaching. Metric types include compliance activities, CM and UM activities, clinical status outcomes, medical cost trend implications for ... CM and UM , staffing/ attrition recommendations, medical cost savings initiatives and tracking, new program design staffing models, and more** **.** **Design and… more
- University of Miami (Coral Gables, FL)
- …here (https://www.myworkday.com/umiami/d/task/1422$7248.htmld) to log in to Workday to use the internal application process. To learn how to apply for a faculty ... . The U Innovation Office has an exciting job opportunity for a Director of The Launch Pad reporting to the Vice Provost of U Innovation… more
- CareFirst (Baltimore, MD)
- …strategic business partners. This role encompasses six distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization ... based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization management… more
- Catholic Health Services (Melville, NY)
- …Minimum Qualifications: 1. Minimum Education/Training Required: Graduate of an accredited medical school. Completion of specialty residency (ie, Internal ... the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health… more
- Elevance Health (Hermitage, PA)
- …Health Services** will be responsible for Behavioral Health Utilization Management (BH UM ), or Behavioral Health Case Management (BH CM) or a combination of ... make an impact:** + Serves as a resource for medical management programs. + Identifies and recommends revisions to...of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. +… more
- LA Care Health Plan (Los Angeles, CA)
- …and CPT codes. Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes ... Job Summary The Supervisor, Authorization Technician supports the Utilization Management ( UM ) Specialist by handling all administrative and technical functions of… more