- NorthBay Health (Fairfield, CA)
- …Health this Director provides oversight for all aspects of Care Management and Population Health which includes: Utilization Management, Utilization Review, ... Denial Management, and Social Services for the NorthBay Healthcare Group. This director will collaborate with Quality and Operations leadership to support key… more
- VNS Health (Manhattan, NY)
- …through regular audits and other evaluative measures to maintain high-quality care standards.Plans leadership and medical director meetings as stipulated ... care to members with behavioral health and social care needs staying current with the latest clinical...minimum of 4 years in a BH utilization and care management Director or above leadership role… more
- Magellan Health Services (Honolulu, HI)
- …utilization data. Strong verbal and written communications skills. General Job Information Title Director , Clinical Care ( UM /BH), HMSA, Licensed/Reside ... of a high quality team and effective transitions of care with the clinical care ...care standards in the participating provider network, vendors, UM staff, Health Guides, and for case managers. +… more
- AmeriHealth Caritas (Charlotte, NC)
- …appropriately identify and refer requests to the Medical Director when indicated. The Clinical Care Reviewer UM will ensure that treatment delivered is ... **RN Clinical Care Reviewer, UM , Exchange Plan** Location: Charlotte, NC Primary Job Function: Medical Management ID**: 34459 **Job Brief** Must be a… more
- Kepro (AR)
- …a vital partner for health solutions in the public sector. Acentra is looking for a Clinical Director to join our growing team. Job Summary: The Clinical ... deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements… more
- WellSense (Boston, MA)
- …Process + At the direction of the Senior Director of BH Clinical Programs, independently leads new BH UM program development and implementation, starting ... coordination and integration between UM and other clinical departments (eg Care Management, Pharmacy, and...of UM activities. + Notifies the Senior Director of BH Clinical Programs if department… more
- Humana (Frankfort, KY)
- …and help us put health first** The Director of Utilization Management ( UM ) Cost of Care Strategy provides data-based strategic direction to identify and ... at large. The Director of Utilization Management ( UM ) Cost of Care Strategy requires an... care in order to improve cost of care and clinical outcomes; identify efficiencies; and… more
- Elevance Health (Topeka, KS)
- ** Director I HCMS - UM /CM -...care field and a minimum of 8 years clinical experience including prior management experience; or any combination ... Elevance Health location (Olathe, Kansas City or Topeka) The ** Director I HCMS - UM /CM** is responsible...UM /CM** is responsible for managing the utilization or care management process for one or more member product… more
- Elevance Health (Miami, FL)
- … clinical consultation and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a ... Director Associates. May be responsible for an entire clinical program. How you will make an impact: +...Leads, develops, directs, and implements clinical and non- clinical activities that impact health care quality… more
- Apex Health Solutions (Houston, TX)
- …office staff when benefit coverage or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in ... Summary: The UM Reviewer serves as a contact and resource...cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans and… more
- University of Maryland, Baltimore (Baltimore, MD)
- …School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), located just outside ... Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care . The Chair will be responsible for directing and supervising the care… more
- Apex Health Solutions (Houston, TX)
- Position Summary: Responsible for providing care management and utilization management services and support to improve health outcomes via a coordinated approach. ... The Care Manager works in collaboration and continuous partnership with...coverage determinations with the leadership of the BH medical director Identify members at risk for poor outcomes, or… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …**Education, Knowledge, Skills and Abilities Required:** + RN, BSN, or Bachelors degree in a clinical field with a health care focus + Minimum five years of ... communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director...clinical experience in a behavioral health care setting. + Excellent written and verbal communication skills.… more
- University of Maryland, Baltimore (Baltimore, MD)
- … clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale initiative focusing on computational ... to supervise and mentor staff and fellows within the UM -IHC, and may provide clinical service in...faculty and trainees. If the candidate will provide patient care through clinical responsibilities, a medical degree… more
- CVS Health (Columbus, OH)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to...the Department. **Required Qualifications** * Minimum of 5 years clinical experience in direct patient care . *… more
- LA Care Health Plan (Los Angeles, CA)
- …RN II is responsible for ensuring that delegates contracted to perform Utilization Management ( UM ) functions on behalf of LA Care (LAC) is in compliance with ... liaison between the Plan Partners and PPGs and LA Care Health Plan regarding UM issues. The...includes liasing with internal Behavioral Health units, the Medical Director of Behavioral Health, attendance at UM … more
- City and County of San Francisco (San Francisco, CA)
- …and California Advancing and Innovating Medi-Cal (CalAIM) and their impacts on clinical care + Collaborates with the Director of Managed Care and with ... its Managed Care division which oversees the Office of Coordinated Care (OCC), Utilization Management ( UM ), and Quality Management (QM). Additionally, BHS… more
- Catholic Health Services (Rockville Centre, NY)
- …and reporting physician and hospital outcomes. Educates members of the patient care team regarding clinical documentation and regulatory coding updates. Duties ... and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... 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 Management… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …medical necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director ... care about your success. The Utilization Management ( UM ) Director is responsible for the market(s)...need the following: + Bachelor's degree in Nursing, Health Care Administration oradvanced clinical degree. + Minimum… more
