- Evolent Health (Nashville, TN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Director , Utilization Management, you'll work with your managers, front line clinical team, and ... for our members, providers, and customers. **Collaboration Opportunities:** The Director , Utilization Management, will partner with a variety of different… more
- Elevance Health (Nashville, TN)
- …within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral health medical ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you will… more
- Vanderbilt University Medical Center (Nashville, TN)
- …performance. Effectively utilizes department Physician Advisors and Medical Directors (TMO & UM ) to intervene when continued stay criteria are not met. Serves as ... resource to facilitate complex cases and escalate concerns and feedback to department Director /Vice President. Position Shift: Mon - Fri; 40 hrs/wk 8 am - 4 pm (must… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …appropriate coordination of care\. + Seek the advice of the Medical Director when appropriate, according to policy\. + Assists non\-clinical staff in performance ... for letters, retrospective claim review, special review requests, and UM pre\-certifications and appeals, utilizing medical appropriateness criteria, clinical… more
- Highmark Health (Nashville, TN)
- …in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to… more