- CVS Health (Hartford, CT)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment… more
- CVS Health (Hartford, CT)
- …Island, Massachusetts, Vermont, New Hampshire, Massachusetts or Maine. The Medical Director will be responsible for overseeing the utilization review for health ... in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a New England...of the states in the New England Region *Previous UM experience with a Health Plan / Payor. *Previous… more
- CVS Health (Hartford, CT)
- …health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our Models of Care ... physical, behavioral and socioeconomic needs. * Partner closely with the Executive Director of Duals and other Duals Care Management leadership to collaborate across… more
- Evolent Health (Hartford, CT)
- …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
- CVS Health (Hartford, CT)
- …and exciting ways every day. Aetna is recruiting for an Executive Director , Medicaid Provider Experience Standardization who is responsible for ensuring the ... PCPs are terminated. + Reviewing active prior authorizations and informing the UM /CM departments prior to the completion of the termination to ensure continuity… more
- Evolent Health (Hartford, CT)
- …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 (Hartford, CT)
- …Prime's functional areas: Clinical Program Management, Utilization Management ( UM ), Formulary, GuidedHealth, Pharmaceutical Trade Relations, Pharmacy Audit, Clinical ... and process support for Prime National and Client Utilization Management ( UM ) programs, review of regulatory requirements and adherence for processes related… more
- Bear Mountain Health Care (West Springfield, MA)
- …and regulations that govern our facility, and as may be required by the Director of Nursing Services, to ensure that the highest degree of quality care is ... weekend. Some 12-hr shifts (7a-7p) will be required in the case of a call out, where UM would need to be on a cart. Benefits: + 401(k) + Dental insurance + Health… more