- Almost Family (Oshkosh, WI)
- …the delivery of services to patients. Collaborates with the Agency Director regarding referral acceptance, assists in determining qualification and appropriateness ... for home care services and establishment of frequencies and utilization for new admissions. Works closely with the Agency... for new admissions. Works closely with the Agency Director regarding coverage, plan of care, and other reimbursement… more
- Central Missouri Home Health (Jefferson City, MO)
- …action to correct adverse findings and communicates trending to clinical director . Reviews, evaluates, and supervises service delivery to ensure appropriateness of ... care and utilization of services, equipment, and supplies through activities such...conferences. Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy. Assists… more
- Home Care Solutions (Thompsons Station, TN)
- …as needed to meet patient needs. Adheres to and participates in the agency's utilization management model. License Requirements Current RN licensure in state of ... video meetings. 5. Teamwork (on call, productivity) Takes direction from Clinical Director and Executive Director professionally and completes tasks assigned… more
- Saint Francis Health System (Tulsa, OK)
- …Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective interpersonal, ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- Saint Francis Health System (Tulsa, OK)
- …and support decision-making. Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Ability to receive ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care… more
- Ascension Health (Baltimore, MD)
- …Ascension Saint Agnes is seeking a dynamic and experienced Director of Case Management & Utilization Management . In this position you will play a ... **Details** + **Department:** Case Management & Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint… more
- Geisinger (Harrisburg, PA)
- …Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of ... provide effective and meaningful educational programs across the department. Responsible for management of the Utilization Review policy and observation … more
- Ascension Health (Austin, TX)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and claims processing. + Oversee work with provider relations on resolving issues. + Manage… more
- Molina Healthcare (CA)
- … Director of Healthcare Services position will be overseeing the Outpatient Utilization Management Team. Candidates must have an active California Nursing ... of the following key Healthcare Services functions: case management /disease management /care transitions; utilization management (Position oversees PA… more
- Carle (Urbana, IL)
- …of multidisciplinary team members and the medical staff. + Collaborates with the System Director Utilization Management and Clinical Denial Management . + ... Director of Regional Care Management East/South...of care + Effectively reduces hospital readmissions and inappropriate utilization of hospital resources. + Provides regular updates to… more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- Ascension Health (Baltimore, MD)
- …leadership and Sr Dir of CM as appropriate * Performs other duties as assigned Utilization Management : + Ensures integration of utilization management ... insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs. + Oversees implementation and maintenance of… more
- CVS Health (Springfield, IL)
- …to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and ... Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Providence (Torrance, CA)
- **Description** Under the supervision of Regional Director of Care Management , the Utilization Management Coordinator is responsible for providing ... support to the Care Management team who coordinates care. This position works closely...**Job Shift:** Day **Career Track:** Admin Support **Department:** 7000 UTILIZATION MGMT CA SOCAL **Address:** CA Torrance 4180 W… more
- Nuvance Health (Norwalk, CT)
- …including discharge planning, utilization management and high-risk case management . Works collaboratively with the Director of transitions to ensure ... State and Federal Regulations relative to Discharge Planning, Utilization Management and Continuum of Care. Director Care Coordination- Major… more
- AmeriHealth Caritas (Newark, DE)
- …and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the ... (SMO) experience preferred. + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization… more
