- AmeriHealth Caritas (Orlando, FL)
- ** Medical Director , UM Review , Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be ... to practice in any state licensed in as a medical director . Additional state licensure required in...within 3 months of employment. 5+ yrs clinical practice. UM /Care Coordination exp. preferred. Your career starts now. We… more
- Elevance Health (Las Vegas, NV)
- …to Medicaid plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral ... identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.… more
- Elevance Health (Louisville, KY)
- …must live within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.… more
- Elevance Health (Atlanta, GA)
- …within 50 miles of one of our Elevance Health office locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.… 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 ... the policies and procedures approved by the physician group Medical Directors and UM Committees. * 7...in the state of CA - 1-2 years of UM experience OR reverse review experience and… more
- Apex Health Solutions (Houston, TX)
- …pending cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans and ... resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM ...questionable admissions, and prolonged lengths of stays to the Medical Director for determination. *Collect accurate data… more
- CVS Health (Springfield, IL)
- …clinical support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... clinical support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior… 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 ... health services, including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective leadership and… more
- University of Michigan (Ann Arbor, MI)
- …Medical School is seeking an experienced Director to lead the Medical School's Institutional Review Board Medicine (IRBMED) team (IRBMED Director ).The ... Institutional Review Board Director , Michigan Medicine Apply...(particularly those articulated in the Belmont Report). The IRBMED Director reports to the Medical School Associate… 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 ... highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300...more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- Healthfirst (NY)
- …from these committees. When needed, manage peer review and clinical case review activities for UM , CM and A&G using approved policies and procedures ... Experience with public speaking, public communication, and training others Experience usingCM/ UM software and electronic medical records Clinical experience with… more
- Baylor Scott & White Health (Temple, TX)
- …plan and network managed care performance. + Partner with Provider Networks and Medical Director team in creating and maintaining programs that incentivize ... by the state and federal regulatory agencies, the Quality management Committee, Medical Advisory Committee, Peer Review Committee, and management. + Help… more
- YesCare Corp (Cumberland, MD)
- …disabled Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality ... is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare: **Administrative:** +...safety and chart and site audits. + Adherence to UM programs specific to the contract requirements and corporate's… more
- Kepro (Indianapolis, IN)
- …for health solutions in the public sector. Acentra seeks a Behavioral Health Medical Director -Psychiatrist OR HSPP with an Indiana, Michigan, or Illinois license ... join our growing team. Job Summary: The Behavioral Health Medical Director shall provide the clinical and...State of Indiana, Michigan, or Illinois + Utilization Management ( UM ) review experience + Experience as a… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- University of Miami (Coral Gables, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... of Miami has a great opportunity for an Assistant Director , Academic Advising to work at the Coral Gables...and outreach to ensure students are completing Road to UM tasks, Road to UM modules, and… more
- CVS Health (Columbus, OH)
- …illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical coverage ... Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line... review , member appeals clinical review , ... review , member appeals clinical review , medical claim review , and… more
- AdventHealth (Maitland, FL)
- …prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization, claims ... role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs,...with the other medical directors..Participates with the Medical Directorate to review and develop … more
- University of Miami (Miami, FL)
- …OPO certification to all LAORA staff within 2 years of hire. + Work closely with Medical Director , Director of Operations, and the Executive Director to ... areas of organ donation. + Work closely with the Medical Director , Director of Operations...in an effort to help other members of the medical community learn from the UM OPO… more
- CVS Health (Hartford, CT)
- …personal, convenient and affordable. Job Purpose and Summary: The LTSS/SAI National Senior Medical Director , reporting to a Regional CMO of Medicaid, will ... Procedures for utilization and case management.* Implements clinical practice guidelines and medical necessity review criteria.* Tracks all clinical programs for… more