- Kepro (AR)
- … UM contract for Arkansas Medicaid. Job Responsibilities: + Collaborate with Medical Director and other Dental Physician Reviewers on case consultations as ... public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary:...Utilization Management reviews. + Develop and complete an annual review of clinical medical necessity criteria. +… more
- ManpowerGroup (Columbia, SC)
- … review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of care ... **Title:** **Managed Care Coordinator UM II** **Location: Columbia SC (Onsite)** **Duration: 3...to promote quality, cost effective outcomes. + 50% Performs medical or behavioral review /authorization process. + Ensures… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points ... medical necessity to Physician Advisor for determination. + Review clinical and diagnostic interventions for appropriateness and timeliness to achieve… more
- CVS Health (Columbus, OH)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization… more
- City and County of San Francisco (San Francisco, CA)
- …specifically in the Mental Health Service Center + Supervises medical staff, including UM Medical Director , OCC Nurse Practitioner, and the medical ... health services, including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective leadership and… more
- Dignity Health (Bakersfield, CA)
- …week, and will be expected to work within PST business hours.** **Position Summary:** The Medical Director of UM reports to the Chief Physician Executive ... will provide leadership oversight to medical physician reviewers and network medical directors who support UM reviews, ensuring consistency, quality and… more
- Catholic Health Initiatives (Lexington, KY)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central...and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- Dignity Health (Bakersfield, CA)
- …including preservice utilization review , concurrent inpatient review , and retro claim review . The UM Director is also responsible for the oversight ... providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a...for bringing on new lines of business into the UM workflow. The Director is responsible for… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... This is a part time position doing case review , remote work from home, and the work...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- CVS Health (Jackson, MS)
- …license without encumbrances in one (1) of those five (5) states. + In the Medical Director role you will provide oversight for medical policy ... consistent responses to members and providers. + As a Medical Director you will focus primarily on...Director you will focus primarily on overseeing utilization review and quality assurance while being responsible for predetermination… more
- CVS Health (Columbus, OH)
- …illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical coverage ... Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line...review , member appeals clinical review , ...review , member appeals clinical review , medical claim review , and… 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...accord with institutional research processes * Conducts physician peer review activities as requested by medical staff… 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
- CVS Health (Carson City, NV)
- …License ( Washington, Utah, Idaho, Montana will also work) without encumbrances. In the Medical Director role you will provide oversight for medical policy ... and consistent responses to members and providers. **As a Medical Director you will focus primarily on...Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination… more
- Evolent Health (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the utilization management team. ... Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a member of...members + Supports design and implementation of health plan medical policies, and appropriate Care Management and UM… more
- Molina Healthcare (Starkville, MS)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Director ... Contracting & Strategic Sourcing to work at the UHealth Medical Campus. Core Job Summary The Director ,...is responsible for training supply chain staff on contract review and negotiation strategies and acts as the department's… 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
- Molina Healthcare (Louisville, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all...for quality compliance. * Implements clinical practice guidelines and medical necessity review criteria * Tracks all… more
- Fallon Health (Worcester, MA)
- … + Member appeals review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology review ... to practice medicine in MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management; network management; medical… more