- CHRISTUS Health (Tenneryville, TX)
- …in matters related to nursing service and strategies Standard I: Financial Management . Recognizes the impact of reimbursement on revenue . Understands the ... Documents capital appropriations and project authorizations Standard II. Human Resources Management . Evaluates and specifies the critical resources required to… more
- CHRISTUS Health (Tenneryville, TX)
- …high-quality, cost-effective care to patients. Responsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes ... for effective supervision of nursing activities of assigned area(s). Assists management of financial and human resources to ensure services meet established… more
- Prisma Health (Columbia, SC)
- …evaluating teaching plan (encourages patient/family involvement/participation)-Micromedex utilization -Computer resourcesCommunicates the patient/family's need for ... collaboratively with the physician(s) and other members of the healthcare team.Supervisory/ Management ResponsibilityThis is a non- management job that will report… more
- 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 ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...responsible for the design, assessment, implementation and outcomes of utilization management strategies using a multidisciplinary approach… more
- WellSpan Health (York, PA)
- …Utilization Management Review Committees. Co-chair's System Utilization Management Committee. + Works closely with Medical Director to identify trends ... Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares reports for… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Catholic Health Initiatives (Lexington, KY)
- …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… more
- AnMed Health (Anderson, SC)
- …and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at AnMed. The Medical Director ensures the program and ... The Utilization Review Medical Director supports operations...the leadership and staff who perform the functions of Utilization Management (UM), Case Management … more
- UCLA Health (Los Angeles, CA)
- …timely communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team to ensure ... Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality issue… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . ... transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral… more
- Independent Health (Buffalo, NY)
- …benefits and commitment to diversity and inclusion. **Overview** The Associate Medical Director , Utilization Management is responsible for assisting the ... Medical Director in the oversight of Utilization Management (UM) programs and will support the development and maintenance of these programs, with focus on… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Sacramento, CA)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Martin's Point Health Care (Portland, ME)
- …applicable managed care experience with progressively increasing responsibilities in medical director capacities, including utilization management and ... and executes on all aspects of the health plan's medical policy, clinical utilization management programs and clinical benefit determinations. This role works… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
