- CHRISTUS Health (Tenneryville, TX)
- …and teams; identifying and addressing staff training and development needs * Medical staff, department heads, and administrators in matters related to nursing ... service and strategies Standard I: Financial Management . Recognizes the impact of reimbursement on revenue...baseline for comparison . Discovers opportunities to improve resource utilization . Implements changes in role consistent with scope… more
- CHRISTUS Health (Tenneryville, TX)
- …high-quality, cost-effective care to patients. Responsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes ... for effective supervision of nursing activities of assigned area(s). Assists management of financial and human resources to ensure services meet established… more
- Prisma Health (Columbia, SC)
- …nursing units within the scope of RN practice. This scope includes medical -surgical, telemetry, progressive and intensive care, or emergency department, for any ... clarify ideas-implementing and evaluating teaching plan (encourages patient/family involvement/participation)-Micromedex utilization -Computer resourcesCommunicates the patient/family's need for education/teaching to others… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director ...Utilization Management programs at AnMed. The Medical Director ensures the program and associated ... the leadership and staff who perform the functions of Utilization Management (UM), Case Management ...practice preferred. + Minimum of five years post residency medical practice experience with hospital, managed care or long-… more
- UCLA Health (Los Angeles, CA)
- …that clear, timely communication is provided to all stakeholders. + Working closely with medical director , utilization management and quality review team ... Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality issue… more
- WellSpan Health (York, PA)
- …Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares ... and oversees the operations of the utilization management department. Works with hospital, regional, medical ... Management Committee. + Works closely with Medical Director to identify trends in payor… more
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Associate Medical Director , Utilization Management is responsible ... for assisting the Medical Director in the oversight of Utilization Management (UM) programs and will support the development and maintenance of these… 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 actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Sacramento, CA)
- …Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds… 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 ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Martin's Point Health Care (Portland, ME)
- …managed care experience with progressively increasing responsibilities in medical director capacities, including utilization management and medical ... to Work" since 2015. Position Summary The Health Plan Medical Director provides leadership for the clinical...and executes on all aspects of the health plan's medical policy, clinical utilization management … more
- LA Care Health Plan (Los Angeles, CA)
- …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- CVS Health (Oklahoma City, OK)
- …a regional role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management ) Medical Director will be a "Work from ... convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- Catholic Health Initiatives (Lexington, KY)
- …can happen both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) ... 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 . 8. Implements utilization … 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
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review, Commercial inpatient and outpatient behavioral health… more
- Ascension Health (Nashville, TN)
- …to Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...optimize patient care, and partner with the National Senior Director of UM to align on organizational goals. Ready… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
