- Independent Health (Buffalo, NY)
- … Director , Utilization Management is responsible for assisting the Medical Director in the oversight of Utilization Management ( UM ) programs and will ... with focus on clinical accuracy and appropriateness. The Associate Medical Director (AMD) will assist the ... specialty as recognized by the American Board of Medical Specialists (ABMS), preferably in Primary Care ( internal… more
- USAA (New Orleans, LA)
- …Come be a part of what makes us so special! **The Opportunity** As a dedicated Director , Trial Attorney (BI/ UM ) you will lead a team of Legal Assistants and ... firm staff provides the highest level of service for clients and internal customers. Exercises discretion and judgment in litigation and legal proceeding matters… more
- Kepro (AR)
- …supervision of the Program Director and in collaboration with the Clinical Director and Medical Director , the Team Supervisor oversees clinical staff ... the public sector. Acentra is looking for a Dental UM Supervisor (Remote within Arkansas) to join our growing...continuous learning needs and, in collaboration with the Clinical Director and Program Director , develop and implement… more
- ManpowerGroup (Columbia, SC)
- …review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + Participate in ... + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required...extension) **Role Overview** This role involves reviewing and evaluating medical or behavioural eligibility for benefits and clinical criteria… more
- Healthfirst (NY)
- …**Duties and Responsibilities:** + Responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly reports ... medicine, and trends in medicine. + Work with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions Supervises, evaluates,… more
- CVS Health (Sacramento, CA)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... 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
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management ( UM ) functions for physical health ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... Officer. **Required Qualifications** + Doctor of Medicine (MD) - Internal Medicine or Family Practice + **OR** Doctor of...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Catholic Health Initiatives (Lexington, KY)
- …necessity determinations; processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops ... 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central...and out in the community. **Responsibilities** The Utilization Management ( UM ) Director is responsible for the market(s)… more
- Magellan Health Services (San Diego, CA)
- …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
- Magellan Health Services (Hodge, LA)
- The ECSS Clinical Director will have oversight and monitoring of ECSS site-developed assessments and Plans of Care to ensure the highest level of standards of care ... in Louisiana, candidates must reside in Louisiana. Maintains accountability for medical management functions to achieve the business and clinical outcomes for… more
- CVS Health (Hartford, CT)
- …Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Massachusetts or Maine. The Medical Director will be responsible for overseeing the utilization ... performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have...of the states in the New England Region *Previous UM experience with a Health Plan / Payor. *Previous… 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
- University of Miami (Miami, FL)
- …for a Director , Contracting & Strategic Sourcing to work at the UHealth Medical Campus. Core Job Summary The Director , Contracting and Strategic Sourcing (H) ... 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… more
- CVS Health (Albany, NY)
- …NY License without encumbrances or the ability to obtain a NY License. In the Medical Director role you will provide oversight for medical policy ... staff ensuring timely and consistent responses to members and providers. **As a Medical Director you will focus primarily on overseeing utilization review /… more
- Magellan Health Services (Albuquerque, NM)
- …Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... staff and physician advisors. Ensures adequate physician resources. Develops and manages medical director and physician advisor budgets, travel budgets, and… more
- VNS Health (Manhattan, NY)
- …other evaluative measures to maintain high-quality care standards. + Plans leadership and medical director meetings as stipulated by the State BH contract ... company holidays + Health insurance plan for you and your loved ones, Medical , Dental, Vision, Life and Disability + Employer-matched retirement saving funds +… more
- Healthfirst (NY)
- …and business leader coaching. Metric types include compliance activities, CM and UM activities, clinical status outcomes, medical cost trend implications for ... CM and UM , staffing/ attrition recommendations, medical cost savings initiatives and tracking, new program design staffing models, and more** **.** **Design and… more