- Community Health Plan of Washington (Eugene, OR)
- …against criteria utilized for medical review. * Regularly communicates with the UM Manager, Medical Director , physician advisor/reviewer and primary care ... Prepare cases that do not meet medical necessity or criteria for medical director review. * Communicate effectively with medical director regarding identified… more
- AmeriHealth Caritas (Orlando, FL)
- **Medical Director , UM Review, Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to ... practice in any state licensed in as a medical director . Additional state licensure required in all states where...within 3 months of employment. 5+ yrs clinical practice. UM /Care Coordination exp. preferred. Your career starts now. We… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Director of Utilization Management ( UM ) Cost of Care Strategy provides data-based strategic ... support for business segments or the company at large. The Director of Utilization Management ( UM ) Cost of Care Strategy requires an in-depth understanding of… more
- Evolent Health (Columbus, OH)
- …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
- Insight Global (Irvine, CA)
- Job Description Under the general direction of the Director of UM , UM Manager, and the UM Supervisor, the Prior Authorization LVN ensures that prior ... nationally recognized guidelines, criteria, and evidence based standards. Also assists UM management and Compliance team in preparation for audits and other… more
- CVS Health (Springfield, IL)
- …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
- 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
- Elevance Health (Las Vegas, NV)
- …plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral health medical ... of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. **This position… more
- Elevance Health (Atlanta, GA)
- …50 miles of one of our Elevance Health office 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
- Virginia Mason Franciscan Health (Bremerton, WA)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s) development, implementation,… more
- Intermountain Health (Las Vegas, NV)
- …As the UM Physician Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director of Claims, to conduct peer-to-peer reviews ... claims appeal providers. In addition, the role will provide UM related training and education for peer-to-peer reviews, prior...peer-to-peer reviews, prior authorization reviews, and other education within UM as determined by UM Medical and… 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 staff of ... division which oversees the Office of Coordinated Care (OCC), Utilization Management ( UM ), and Quality Management (QM). Additionally, BHS will be standing up the… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- Nuvance Health (Norwalk, CT)
- …cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. ... Case Managment /Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social… more
- Healthfirst (NY)
- …clinical and medical departments + Conduct ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. + Collaborate with ... + Support the Medical Policy and Clinical Utilization Management ( UM ) Governance Committee Chairs, committee members, and related workgroups by… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists UM Educator/Manager/ Director ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Documents in platform/system of record. Utilizes designated software ... and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management… more
- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM ... pending cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans and interface… more
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, as required, ... denials for medical necessity are issued under the direction of the Medical Director or designee. Assists with transfers, when necessary. + Demonstrates knowledge of… more
- LA Care Health Plan (Los Angeles, CA)
- …required to achieve that purpose. Job Summary Under the general direction of the Director of Utilization Management ( UM ) the Program Manager II is responsible ... leading and managing a portfolio of strategic and transformational UM programs and projects that are generally complex and...Expected to serve as a strategic thought partner with director and senior management leadership team members to advise… more
