- Monogram Health (Fort Myers, FL)
- …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
- VitalCore Health Strategies (Augusta, GA)
- …Event Committee, Performance Improvement, Electronic Medical Records (EMR), Utilization Management and other process improvement committees/initiatives ... and reviews minutes on a regular basis for MAC meetings, Disease Management /Case Review and other healthcare-related site meetings. Reinforces and strengthens… more
- Defense Health Agency (San Antonio, TX)
- …Department or Hospital board or committee meetings. Participates in the clinic Utilization Management and Quality Assurance processes. Attends Continuing Medical ... objectives. The incumbent exercises independent judgment in the medical treatment and management of patients and Internal Medicine Clinic (IMC) with the full range… more
- VitalCore Health Strategies (Baraga, MI)
- …clinical quality and integrity of patient medical care including oversight of utilization and quality management , credentialing, and best practice guideline ... managed healthcare systems, medical quality assurance, quality improvement and risk management is required Must have experience in launching and managing innovative… more
- Trinity Health (Syracuse, NY)
- …Collaborate with the administrative team to oversee department activities. Manage cost management , utilization review , quality assurance, and medical ... guidelines and assist in policy/procedure development. Oversee clinical peer review , documentation, and care planning. Assist with clinical patient complaints… more
- Jazz Pharmaceuticals (Palo Alto, CA)
- …analyses, and other advanced analyses as required for brand performance assessment/ management Evaluate product utilization data (internal and external) at ... team to contribute and co-lead cross-functional Team Meetings and National Business Review meetings, which serve as a strategic platform to share market insights… more
- HCA Healthcare - Chief Medical Officer (Bradenton, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- Fresenius Medical Care (Olmito, TX)
- …Preparedness Plan; ensure maintenance of equipment . Ensure proper medical records management and HIPAA compliance . Oversees the continuous and data driven Quality ... and policies, and then developing and implementing an associated center specific management plan. . Ensure adverse events are reported, documented and necessary… more
- Vista Community Clinic (Vista, CA)
- …technicians and other staff. Participate in quality assurance, quality improvement and utilization review Provide in-service training to clinic staff to increase ... of clinic protocols and procedures to ensure quality medical care Participate in utilization and peer review programs which evaluates the quality of the… more
- UTMB Health (Galveston, TX)
- …to budget planning, fiscal and resource planning/administration, human resource utilization , policy administration, and coordination and negotiation of activities ... followed accordingly with regard to faculty appointments, promotions, and tenure review . Identifies and adheres to appropriate internal controls for department and… more
- Saint Vincent Hospital (Worcester, MA)
- …clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to ... to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to… more
- AlliedTravelCareers (Sacramento, CA)
- …Participates in peer review and QM activities as requested. Participates in utilization review of medical records as assigned. Adheres to Agency standards ... Reports all incomplete work assignments to appropriate member of clinical management staff Work in collaboration with InnovAge nursing home and assisted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- Fallon Health (Worcester, MA)
- …strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, ... and staff across all product lines. **Responsibilities** ** Utilization Management :** + Oversees all administrative, operational and clinical functions related to… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... care standards for appropriate utilization of services. Perform utilization management / review for medical necessity for specialty referrals and… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can ... department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… more
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