- AmeriHealth Caritas (Orlando, FL)
- ** Medical Director , UM Review, Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to ... practice in any state licensed in as a medical director . Additional state licensure required in...within 3 months of employment. 5+ yrs clinical practice. UM /Care Coordination exp. preferred. Your career starts now. We… more
- Elevance Health (Las Vegas, NV)
- …to Medicaid plans in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration of physical and/or behavioral ... of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. **This position… more
- Elevance Health (Louisville, KY)
- …must live within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- Elevance Health (Atlanta, GA)
- …within 50 miles of one of our Elevance Health office locations.** The Medical Director is responsible for the administration of physical and/or behavioral ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you… more
- City and County of San Francisco (San Francisco, CA)
- …specifically in the Mental Health Service Center + Supervises medical staff, including UM Medical Director , OCC Nurse Practitioner, and the medical ... health services, including psychiatric services. The Behavioral Health Services (BHS) Deputy Medical Director of Managed Care provides effective leadership and… more
- Nuvance Health (Norwalk, CT)
- …cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. ... Case Managment /Care Coordination Director Location: Norwalk, CT, United States Requisition ID:...Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary… more
- YesCare Corp (Bartow, FL)
- … UM + Reviews requests for outpatient services, codes, and forwards to Corporate UM Medical Director + Performs monthly audit of Inpatient, ER and ... + Minimum of two (2) years prior experience with UM preferred + Minimum of one (1) year prior...each site and participates in Utilization Review with Clinical Director and other personnel as required + Provides assistance… more
- Insight Global (Irvine, CA)
- Job Description Under the general direction of the Director of UM , UM Manager, and the UM Supervisor, the Prior Authorization LVN ensures that prior ... accordance with the policies and procedures approved by the physician group Medical Directors and UM Committees. * 7 Audits and evaluates patient medical … more
- Apex Health Solutions (Houston, TX)
- …coordinate pending cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans ... Summary: The UM Reviewer serves as a contact and resource...questionable admissions, and prolonged lengths of stays to the Medical Director for determination. *Collect accurate data… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- CVS Health (Springfield, IL)
- …clinical support to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior ... to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and… more
- Healthfirst (NY)
- …and medical departments + Conduct ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. + Collaborate with ... **Duties/Responsibilities:** + Support the Medical Policy and Clinical Utilization Management ( UM...the Medical Policy and Clinical Utilization Management ( UM ) Governance Committee Chairs, committee members, and related workgroups… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300...more! **Responsibilities** **Job Summary / Purpose** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- Healthfirst (NY)
- …Experience with public speaking, public communication, and training others Experience usingCM/ UM software and electronic medical records Clinical experience with ... of new or updated formal policy and procedures for UM , CM, Credentialing, Delegation and QA/QI Collaborate with other...as a voting member (as assigned) on Credentialing, QI/QA, UM , CM, A&G and Delegation Committees/Subcommittees acting as an… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- Baylor Scott & White Health (Temple, TX)
- …plan and network managed care performance. + Partner with Provider Networks and Medical Director team in creating and maintaining programs that incentivize ... to interface with providers, staff, and management. + Knowledge of medical , quality improvement and UM practices in a managed care environment. + knowledge of… more
- YesCare Corp (Cumberland, MD)
- …disabled Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality ... is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare: **Administrative:** +...safety and chart and site audits. + Adherence to UM programs specific to the contract requirements and corporate's… more
- Kepro (Indianapolis, IN)
- …for health solutions in the public sector. Acentra seeks a Behavioral Health Medical Director -Psychiatrist OR HSPP with an Indiana, Michigan, or Illinois license ... join our growing team. Job Summary: The Behavioral Health Medical Director shall provide the clinical and...State of Indiana, Michigan, or Illinois + Utilization Management ( UM ) review experience + Experience as a physician executive… more
- University of Miami (Coral Gables, FL)
- …. The University of Miami has a great opportunity for an Assistant Director , Academic Advising to work at the Coral Gables Campus. The Assistant ... Director of Transitional Advising works with undergraduate students to...and outreach to ensure students are completing Road to UM tasks, Road to UM modules, and… more
- University of Maryland, Baltimore (Baltimore, MD)
- …physician-scientist with expertise in clinical trial design and execution to serve as Director of Clinical Trial Innovation.* The UM -IHC is a large-scale ... life and longevity of the citizens of Maryland. The UM -IHC, located in North Bethesda, MD, is a collaborative...of Maryland College Park, and the University of Maryland Medical System, funded with initial grants from the State… more