- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …to promote quality improvement for the facility; this includes participation as a physician utilization management advisor. Participate in VISN 6 Hospital ... Summary The Durham VA Medical Center is recruiting for a full-time Physician (Hospitalist - Section Chief). Applicants must be currently working as a Hospitalist… more
- Randstad US (Boston, MA)
- …Center, Hospital, Insurance Company, Physician office) + Knowledge of Utilization Management regulations and standards + Experience with Medicare, Medicaid, ... Provide support to UM Care Managers to ensure provider and member customer satisfaction. + Process authorizations and...+ Referrals + Medical Billing + medical coding + utilization management + medicare/medicaid + Spanish Qualifications… more
- Kepro (AR)
- …being a vital partner for health solutions in the public sector. The Dental Physician Reviewer will oversee utilization / management (UM) activities to ... contract for Arkansas. + Responsible for the clinical oversight of the Dental Utilization Management program. + Collaborate with Medical Director on case… more
- Beth Israel Lahey Health (Burlington, MA)
- …challenge physician practices to achieve the organization's desired resource management and quality goals. **Job Description:** Purpose: Provide leadership ... and expertise relative to the level of care management , concurrent and retro commercial payer validation of medical...allocation - Serves as physician expert and provide support to utilization review team regarding… more
- AdventHealth (Maitland, FL)
- …our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality ... On Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle...Care Management ..Serves as a member of the Utilization Management (UM) Committee by ensuring committee… more
- WMCHealth (Valhalla, NY)
- …role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + Reviews ... on UM Committee .Provides Physician administrative support and leadership to the utilization and resource management areas of Integrated Case Management … more
- Dartmouth Health (Lebanon, NH)
- …Keene is seeking a Physician Advisor (PA) with expertise in Utilization Management , Care Management , and Clinical Documentation. The PA ... supports Utilization Management by performing concurrent, evidence-based second-level medical necessity reviews, educating physicians on medical necessity for… more
- Kepro (AR)
- …looking for a to join our growing team. Job Summary: The Dental Physician Reviewer-Orthodontist will oversee utilization review/ management activities to ... Dental Physician Reviewers on case consultations s needed. + Discuss complicated Utilization Management reviews or clinical scenarios with + Utilization … more
- Hackensack Meridian Health (Hackensack, NJ)
- …to support, and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management (UM) goals ... a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient… more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Nuvance Health (Rhinebeck, NY)
- …standards and monitoring systems for quality initiatives, patient care review, physician privileging, utilization review, risk management , infection ... a liaison, core faculty, and participant in recruitment and policy review. 3. * Management /Strategy* * Address physician and provider issues, including… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... the business processes and operations for all levels of utilization management review (ie, Precertification and Intake...Directors and/or business leads), plan medical staff and key provider - facility and physician or group… more
- Stanford Health Care (Palo Alto, CA)
- …with the UM/CM Medical Director on strategic issues involving Utilization Management Department programs. + Collaborates with Physician Advisory Services to ... onsite Stanford Health Care job.** **A Brief Overview** The Dir- Utilization Management (UM) leads and shapes the...of services through UR, review of medical records and provider education, while identifying training opportunities and trends. +… more
- Trinity Health (Boise, ID)
- …Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and oversight of our Physician Advisor team and ... as assigned. D. Engage in physician -to- physician communication to provide just-in-time education and resolve conflicts regarding utilization concerns and… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 40** **Position Summary:** Responsible ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- SSM Health (Oklahoma City, OK)
- … leadership and physician coaching for all activities of care management , utilization management , and clinical documentation integrity. Collaborates with ... physician expert, providing medical direction and oversight to care management , utilization management andclinical documentation integrity (CDI)… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will… more
- Veterans Affairs, Veterans Health Administration (San Francisco, CA)
- …Facilitates patient throughput with an ongoing focus on quality and efficiency. Provide Utilization Management consultations for the Emergency Department, ... Summary The Patient Flow Utilization Management / Utilization Review Consultant...Consultant RN functions with advanced knowledge and skills to provide clinical coordination and oversight for their patient population.… more
- Intermountain Health (Murray, UT)
- …evaluation, and innovative management of Select Health's Health Services care management and utilization management programs. Programs include but are ... and other digital platform products to both target and scale operations for utilization management , care management (eg Care Affiliate strategy, digital… more