- Central Missouri Home Health (Jefferson City, MO)
- …care (SOC) visits. Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals. Ensures patient needs are ... all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other… 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 ... psychosocial factors. Documents steps of the nursing process. Utilizes proper medical terminology. Addresses problems and progress toward goals. Facilitates patient… 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, ... psychosocial factors. Documents steps of the nursing process. Utilizes proper medical terminology. Addresses problems and progress toward goals. Facilitates patient… 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 ... nursing evaluation visit, ensures patients meet home health eligibility and medical necessity guidelines as defined by payer source, accurately determines primary… more
- Geisinger (Harrisburg, PA)
- … management of the Utilization Review policy and observation management performance including outcomes of medical necessity justification with health plan ... Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of… more
- CVS Health (Springfield, IL)
- …support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization… 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 an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… 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 an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- AmeriHealth Caritas (Newark, DE)
- …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the CMO. The following ... + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization desired. + Experience… more
- AmeriHealth Caritas (Orlando, FL)
- …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the Vice President, ... ** Medical Director , UM Review, Family Medicine**...Provide organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement and… more
- YesCare Corp (Hanover, MD)
- …Shares information gathered at the quarterly area multidisciplinary CQI Committee meetings with the Utilization Management Medical Director to be used at ... Nurse in Maryland. + Current Basic Life Support/CPR Certification at the Medical Professional Level with AED Training. American Heart Association is the preferred… 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 ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...for medical staff on issues related to utilization management . 1. Implements utilization … more
- Carle (Urbana, IL)
- …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
- CVS Health (Springfield, IL)
- …cases; and can be done from your laptop. Fundamental Components: * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a Medical Director to be part of a...state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another… more
- Trinity Health (Boise, ID)
- …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is… 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
- 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 ...a full-service, 254-bed teaching hospital, the Ascension Saint Agnes Medical Group, Ascension Saint Agnes Imaging Center and Ascension… 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...Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell… more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... the RN Care Coordination Manager, provides support to the utilization management , denials and appeals process for...are met + Collaborates with Physician Advisor to clarify medical necessity or clinical rationale + Assists in corresponding… more
- Intermountain Health (Columbus, OH)
- …In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director , and ... as an expert and local resource to hospital Case Management Department and Medical Staff on issues...Director . + Work with and support the Case Management Department to ensure appropriate admission and discharge status… more
