- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The Utilization Management (UM) Director is responsible for the market(s) ... development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care Coordination… 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,...responsible for the design, assessment, implementation and outcomes of utilization management strategies using a multidisciplinary approach… more
- Point32Health (Canton, MA)
- …we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, ... the business processes and operations for all levels of utilization management review (ie, Precertification and Intake...leadership. The Director oversees and leads medical management activities related to precertification utilization … more
- Dignity Health (Bakersfield, CA)
- …Nevada or Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the ... utilization management nursing teams. They are responsible for the day-to-day...Director is also responsible for the oversight of utilization management auditing, both internal and external,… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford Macomb… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Director of Utilization Management (UM) Cost of Care Strategy provides data-based ... planning support for business segments or the company at large. The Director of Utilization Management (UM) Cost of Care Strategy requires an in-depth… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... This position works with both inpatient and outpatient Care Management nurses to monitor appropriate care and services in...review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology… more
- WellSpan Health (York, PA)
- …Utilization Management Review Committees. Co-chair's System Utilization Management Committee. + Works closely with Medical Director to identify trends ... Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares reports for… 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
- Hackensack Meridian Health (Belle Mead, NJ)
- …third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . ... transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral… more
- VNS Health (Manhattan, NY)
- …within a behavioral health organization (BHO), with minimum of 4 years in a BH utilization and care management Director or above leadership role within a ... manner. + Engages in and contributes to the interdisciplinary team's utilization management activities and recommended interventions for members/participants.… more
- CVS Health (Columbus, OH)
- …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another… more
- Carle (Urbana, IL)
- …of multidisciplinary team members and the medical staff. + Collaborates with the System Director Utilization Management and Clinical Denial Management . + ... Director of Regional Care Management East/South...of care + Effectively reduces hospital readmissions and inappropriate utilization of hospital resources. + Provides regular updates to… more
- Kepro (Indianapolis, IN)
- … shall provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. The Medical Director will be ... Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team. Job Summary: The...clinical specialty if MD or DO. + Experience in Utilization Management (UM) with knowledge of Medicaid… more
- AmeriHealth Caritas (Newark, DE)
- …and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the ... (SMO) experience preferred. + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization… more
- UTMB Health (Galveston, TX)
- …and reports trends of inappropriate resource utilization to Director /Assistant Director of Utilization Management . + Maintains a documentation system ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Monte Nido (Miami, FL)
- …+ Understanding of Medicare medical necessity criteria; consult with Admissions staff and Director of Utilization Management on all evaluations for Medicare ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- CVS Health (Columbus, OH)
- …Account 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… more
- Evolent Health (Columbus, OH)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a...department, you will be a key member of the utilization management team. We can offer you… more