- Elevance Health (Cerritos, CA)
- ** Medical Director - Utilization Management ** **Location: This is a hybrid position with the expectation to go into the office at least 1 day a week, ... within 50 miles of an Elevance Health location.** The Medical Director is responsible for the administration...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… 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
- 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
- Conviva (Columbus, OH)
- …Leadership in Population Health Strategy at Primary Care Organization. The Medical Director conducts Utilization Management of the care received by ... 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
- 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 (Baton Rouge, LA)
- …a regional role that primarily supports the Aetna Better Health Plan of Louisiana. 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
- 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
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… 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
- 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
- Independent Health (Buffalo, NY)
- …recommendations for improvements to maintain an effective and efficient utilization management process, as well as manage medical expenses based on trends. ... process of obtaining approval for any changes from the Medical Director and governing committee(s) then overseeing...industry. + Optimize existing policy as it relates to medical management and utilization … more
- Dignity Health (Rancho Cordova, CA)
- …You can also follow us on Twitter and Facebook. **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM ... processes appeals and reconsiderations. Act as a working manager within Utilization Management , performing essential duties and responsibilities ( utilization… more