- BroadPath Healthcare Solutions (Tucson, AZ)
- …in the Utilization Management process_ + Delivers administrative support for the UM program by collecting member and provider information through phone, ... with referrals to Case Management, Service Coordination and Population Health programs when appropriate _Responsibility B: Supports Appeals, External Medical Review… more
- Katmai (Usaf Academy, CO)
- …and civilian healthcare providers and staff and uses Utilization Management ( UM ) systems support to identify high-risk/high-cost patients within MTF population. + ... with healthcare providers to ensure appropriate appointment alternatives, access and quality of care. + Coordinates services for eligible patients based on… more
- CenterWell (Annapolis, MD)
- …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical ... Director , Primary Care work assignments involve moderately complex to...ABQAURP, or other boarddemonstratingadvanced training in transitions of care, quality assurance,utilizationmanagementand care coordination. + A current and unrestricted… more
- Centene Corporation (Jefferson City, MO)
- …for members. + Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, ... receive medically necessary, evidence-based care aligned with bet practice promoting safety, quality and cost of care outcomes. Assist the Vice President of Medical… more
- Elevance Health (Richmond, VA)
- …May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare service ... leadership in enhancing training and orientation materials. + May complete quality audits and assist management with developing associated corrective action plans.… more
- Integra Partners (Troy, MI)
- …Experience as a health plan medical director + Experience with DMEPOS UM programs , MLTC, Medicaid, or Medicare Advantage + Experience chairing or ... Strategic and Operational Leadership + Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams to drive… more
- Integra Partners (Troy, MI)
- …inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program . + Serve as a clinical resource for UM ... The Utilization Review Medical Director is responsible for conducting clinical reviews of...(DME) and related requests to support Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a… more
- CVS Health (Springfield, IL)
- …inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (ie, ... provides clinical oversight and mentorship for CVS Health clinical programs , PBM Clinical Quality activities, consultative support... director will become sufficiently skilled in various UM programs to support other segments (including… more
- UNC Health Care (Morrisville, NC)
- …that includes key statistics that impact the success of the organization and the UM program . 2. **Leading People** - Operational oversight of centralized and ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a...compliance with healthcare regulations, measure the effectiveness of the UM program including length of stay (LOS),… more
- Wellpath (Lemoyne, PA)
- …UM updates and participate in meetings. + Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and ... * Tuition Assistance and dependent Scholarships * Employee Assistance Program (EAP) including free counseling and health coaching *...is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and… more
- Healthfirst (NY)
- …identify areas for improvement** + **Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program , sometimes through the ... requirements** + **Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner** +...subject matter expert on business development efforts related to UM programs , including the launch of new… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... email address. **Job:** **Faculty* **Organization:** **School of Medicine - Centers/ Programs /ORCs* **Title:** *Physician-Scientist, Director Of Clinical Trial… more
- Magellan Health Services (Boise, ID)
- … improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various committees ... lines of business (Medicaid, Medicare, and Commercial) and implements programs to support this vision. May serve multiple health...with care managers in order to address cost and quality of care. Provides day to day physician oversight… more
- University of Michigan (Ann Arbor, MI)
- Director (Cell and Gene Therapy Program ) **Early Site Maintenance** We are performing updates and maintenance to our applicant experience. As a result, the site ... for job postings can not be submitted. Apply Now **Job Summary** The Director of the Cell and Gene Therapy Program holds enterprise-wide accountability… more
- Humana (Indianapolis, IN)
- …behavioral and physical health services, including Utilization Management ( UM ), Quality Improvement, and value-based payment programs . The Chief Psychiatrist ... Oversees, monitors, and assists with effective implementation of the Quality Management (QM) program ; and work closely...program ; and work closely with the Utilization Management ( UM ) of services and associated appeals related to adults… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Point32Health (MA)
- …not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare. Serving nearly 2 million members, Point32Health ... are at Point32Health (https://www.point32health.org/) . **Job Summary** The Medical Director , Clinical reviews will primarily perform utilization management and… more
- CVS Health (Tallahassee, FL)
- …as needed. * Develop and guide the implementation of Medical Management programs to ensure providers deliver appropriate, high- quality , cost-effective Health ... DSNP/FIDE populations, including the development and implementation of clinical initiatives and programs to address the needs of the populations managed to improve… more
- Molina Healthcare (Tampa, FL)
- …adjustment, disease management, and evidence-based guidelines. + Experience in Utilization/ Quality Program management + HMO/Managed care experience **PREFERRED ... requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the following...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates… more
