- UnitedHealth Group (Raleigh, NC)
- … directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews ... and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement...in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical... reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance… more
- UnitedHealth Group (Dallas, TX)
- …in care, deliver seamless experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, ... review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff… more
- Community Health Systems (Franklin, TN)
- Job Summary The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Community Health Systems (Franklin, TN)
- Job Summary The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals ... secure timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities,… more
- Tris Pharma (Monmouth Junction, NJ)
- …have an opening in our Monmouth Junction, NJ facility for a Director , Market Access, OperationsThis position is responsible for managing the operational ... contracting, pricing governance, government compliance, and vendor management. The Director orchestrates complex cross-functional workflows, manages day-to-day vendor relationships… more
- Humana (Austin, TX)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... practice management. Utilization management experience in a medical management review organization, such as Medicare...Director , depending on the line of business. The Medical Director conducts Utilization Management… more
- Evolent (Carson City, NV)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... available, within the regulatory timeframe of the request. Utilizes medical /clinical review guidelines and parameters to assure...reliability process. On a requested basis, may function as Medical Director for selecting health plans or… more
- Humana (Austin, TX)
- …a part of our caring community and help us put health first The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & ... this in their daily work. The Medical Director 's work includes computer based review of...practice management Utilization management experience in a medical management review organization such as Medicare… more
- UnitedHealth Group (Chicago, IL)
- … directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews ... and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement...in the Quality Improvement programs for the company. The Medical Director also provides/assists in the direction… more
- Elevance Health (Dearborn, MI)
- …unless an accommodation is granted as required by law. The Medical Director -Dermatology Appeals is responsible for the review of appeals for physical health ... Medical Director -Dermatology Appeals Location: This role...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- UnitedHealth Group (Omaha, NE)
- …Caring. Connecting. Growing together. We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible ... of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level....software and platforms Although the United Health Services ICM Medical Director 's work is typically concentrated in… more
- Kaiser Permanente (Vallejo, CA)
- …the standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... quality improvement evaluations, special projects, and other work for multidisciplinary review ; defining the standards for integrating multiple utilization data… more
- Cardinal Health (Tewksbury, MA)
- …meet ET goals Utilizes DCOA as an objective tool to work with specific Medical Staff Departments or Utilization Management Teams to improve medication ... the Commonwealth of Massachusetts. JOB OBJECTIVE Reporting to the Health System Director of Pharmacy (HSD), Director of Pharmacy Operations and Account… more
- Florida Atlantic University (Boca Raton, FL)
- …account. Position Summary Florida Atlantic University is seeking a Senior Director , Facilities Operations and Infrastructure - Boca Raton, FL. Reporting directly ... to the Assistant Vice President for Facilities Management, the Senior Director of Facilities Operations and Infrastructure is a senior administrative leader… more
- Carnegie Mellon University (Pittsburgh, PA)
- …areas to investigate and solve real-world problems. We are seeking a Director of Accounting Operations. This position provides strategic and operational leadership ... and Social Sciences. Reporting to the Chief Business Officer, the Director oversees all aspects of accounting operations, including financial transactions,… more
- UnitedHealth Group (Dallas, TX)
- …within the US as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the ... US. Primary Responsibilities: Provide daily utilization oversight and external communication with network physicians and hospitals Daily UM reviews - authorizations… more
- UnitedHealth Group (Minneapolis, MN)
- …within the US as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the ... US. Primary Responsibilities: Provide daily utilization oversight and external communication with network physicians and hospitals Daily UM reviews - authorizations… more
- Grant Thornton (Melville, NY)
- As the Corporate Tax Director , you'll be a member of our Corporate Tax Solutions Family and work on business income tax planning, corporate compliance, and ASC 740 ... - all with the resources, environment, and support to help you excel. Success in the Director role is the primary pathway to Partner or Managing Director in our… more
- Fresenius Medical Care North America (Denver, CO)
- …determining project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global ... the consolidation, analysis and reporting of commercial revenue. Develops standards of review and analysis to facilitate accurate and timely analysis of all… more
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