- Evolent Health (Trenton, NJ)
- …value proposition and outcomes that effectively support these programs. + Collaborates with UM Director and Quality Management to develop, implement and maintain ... department. The UM Lead, in collaboration with the UM Manager and Director , ensures compliance with all regulatory standards that include state, federal,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review ... charts at identified review points and attend treatment planning conferences or team meetings, collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of care. Referral of cases with… more
- Evolent Health (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Senior Director , Partner Operations** The Senior Director , Partner Operations serves as ... the go-to expert on client priorities. **Collaboration Opportunities** The Senior Director , Partner Operations role also collaborates with internal teams as… more
- Evolent Health (Trenton, NJ)
- …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. We can offer ... Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical...health plan medical policies, and appropriate Care Management and UM goals and objectives + Population health - collaborative… more
- Evolent Health (Trenton, NJ)
- …a growth mindset as we solve complex business problems. **Collaboration Opportunities** The Director , Client Analyst role will be serving as a strategic advisor to ... medical, pharmacy and ancillary claims data, membership data, clinical operational data ( UM & CM), or other healthcare data- **Required.** + Familiarity with Power… more
- Prime Therapeutics (Trenton, NJ)
- …Prime's functional areas: Clinical Program Management, Utilization Management ( UM ), Formulary, GuidedHealth, Pharmaceutical Trade Relations, Pharmacy Audit, Provider ... and process support for Prime National and Client Utilization Management ( UM ) programs, review of regulatory requirements and adherence for processes related… more
- ChenMed (Philadelphia, PA)
- …foundational business unit of our care model - the center. The Senior Medical Director (SMD) will partner with the Center Director /Center Executive Director ... SMD is an earned title where the Center Medical Director completes all necessary primary care physician (PCP) and...conjunction with the transitional care team; hospital, SNF, post-acute, UM , and home-based services for the division. + Assists… more
- Penn Medicine (Hamilton, NJ)
- …you living your life's work? Summary: + Under supervision from the Director of outpatient services and other clinical directors, provides comprehensive oversight of ... and assist in maintenance of human resource files with director of outpatient services. + Program Development: + Collaborate...Provide support and back up for Utilization Reviewer and UM process + Monitor daily census of program. Collaborate… more