- 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 ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees.… more
- 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 ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees.… 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 ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...represent the company to external entities and/or serve on internal and/or external committees. + May chair company committees.… 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
- CVS Health (Springfield, IL)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM...inter-rater review activities and other quality oversight processes for internal Director UM decisions. If… more
- Healthfirst (NY)
- …Experience with public speaking, public communication, and training others Experience usingCM/ UM software and electronic medical records Clinical experience with ... rounds and peer-to-peer discussions with health systems, vendors and other internal and external collaborators. Participate in the development and implementation of… 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
- 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
- YesCare Corp (Cumberland, MD)
- …disabled Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality ... care. Below is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare: **Administrative:** + Provision of comprehensive… more
- University of Miami (Coral Gables, FL)
- …here (https://www.myworkday.com/umiami/d/task/1422$7248.htmld) to log in to Workday to use the internal application process. To learn how to apply for a faculty ... of Miami has a great opportunity for an Assistant Director , Academic Advising to work at the Coral Gables...and outreach to ensure students are completing Road to UM tasks, Road to UM modules, and… more
- ChenMed (Louisville, KY)
- …for the foundational business unit of our care model - the center. The Senior Medical Director (SMD) will partner with the Center Director /Center Executive ... The SMD is an earned title where the Center Medical Director completes all necessary primary care...conjunction with the transitional care team; hospital, SNF, post-acute, UM , and home-based services for the division. + Assists… more
- CVS Health (Columbus, OH)
- …resistant illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical ... * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community,...Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line… more
- CVS Health (Hartford, CT)
- …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... physical, behavioral and socioeconomic needs.* Partner closely with the Executive Director of Duals and other Duals Care Management leadership to collaborate… more
- University of Miami (Miami, FL)
- …OPO certification to all LAORA staff within 2 years of hire. + Work closely with Medical Director , Director of Operations, and the Executive Director to ... areas of organ donation. + Work closely with the Medical Director , Director of Operations...in an effort to help other members of the medical community learn from the UM OPO… more
- CVS Health (Hartford, CT)
- …personal, convenient and affordable. Job Purpose and Summary: The LTSS/SAI National Senior Medical Director , reporting to a Regional CMO of Medicaid, will ... (SOW)In this role, the selected individual will Partner with internal stakeholders to advocate, promote and champion the vision...LTSS line of business including but not limited to UM , Quality, care management, and network growth as listed… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization,… more
- CVS Health (Lansing, MI)
- …Candidates will reside in Illinois and have a IL License without encumbrances. In the Medical Director role you will provide oversight for medical policy ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...including post-graduate direct patient care experience. Preferred Qualifications: Previous UM experience with a Health Plan / Payor. Board… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- Provides clinical leadership and serves as an internal medical consultant to various divisions and committees to support the development, implementation and ... monitoring of medical management and quality improvement activities\. **Job Description:** **Job...physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on… more
- University of Maryland, Baltimore (Baltimore, MD)
- …Comprehensive Cancer Center (UMGCCC), located in Baltimore, MD are recruiting for a*full-time Medical Director of the University of Maryland St. Joseph Cancer ... in Towson, MD.* *_Administrative duties and responsibilities of the Medical Director role will include, but not...be board certified or board-eligible by the ABIM in Internal Medicine and hematology and/or medical oncology… more