- 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
- HonorHealth (Mesa, AZ)
- …agencies, other hospitals, health plans and vendors, as required. Works closely with the Medical Director , Utilization Management , Nursing, the Chief ... Learn more at HonorHealth.com. Responsibilities Job Summary The Case Management Director is accountable and responsible for...contacts to assure quality service is provided. Partners with medical staff to assure proper utilization of… 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)
- …Information** Reports to a Lead Medical Director . 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 ...Prefer Medical Oncology or Surgery specialties + 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
- 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
- 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
- Henry Ford Health System (Detroit, MI)
- The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... of hospital resources, and continued stays of inpatients. The Medical Director of utilization review...Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data,… 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
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- Molina Healthcare (CA)
- …authorization requests or for additional information as requested by the Medical Director . + ** Utilization Management experience-Health plan or IPA** + ... Experience** 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred. To all current Molina employees: If you are… more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial… 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
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
- ERP International (Nellis AFB, NV)
- …team employing team building concepts in both multi -and inter-disciplinary setting to maintain medical and utilization management goals. Must be able to ... No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality… more
- Trinity Health (Silver Spring, MD)
- …closely related area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of pertinent regulatory, ... **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in… more