- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... This position works with both inpatient and outpatient Care Management nurses to monitor appropriate care and services in...appeals review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the… 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
- CVS Health (Columbus, OH)
- …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 ... 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
- 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
- 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...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical… more
- Stanford Health Care (Palo Alto, CA)
- …the UM/CM Medical Director on strategic issues involving Utilization Management Department programs. + Collaborates with Physician Advisory Services to ... to implement improvements. + Directs the utilization management , concurrent review, prior authorizations medical claims...meetings. + Collaborates with the UM/CM Medical Director team on complex cases. + Ensures Utilization… 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
- Point32Health (Canton, MA)
- …- clinical leadership. The Director oversees and leads medical management activities related to precertification utilization management and discharge ... we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing,… 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 (Columbus, OH)
- …urgent cases 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
- 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
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Director of Utilization Management (UM) Cost of Care Strategy provides data-based ... for business segments or the company at large. The Director of Utilization Management (UM)...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Dignity Health (Bakersfield, CA)
- …Nevada or Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the ... review. The UM Director is also responsible for the oversight of utilization management auditing, both internal and external, for all DHMSO service areas,… more
- Point32Health (MA)
- …as well as any partner entities at the direction of Behavioral Health Medical Director Team Leader for Utilization Management (UM) and/or the Medical ... Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment reviews for...They will work closely with colleagues in UM and Medical Management , and with other departments as… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. 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 Coordination… 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