- Humana (Columbus, OH)
- …opportunities are addressed. They will work closely with established functions inside utilization management ( Medical Director , clinician decision ... verbal communication **Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project Management Professional (PMP)… 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 ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . + Review charts ... and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and...collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of… more
- AmeriHealth Caritas (Newark, DE)
- …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the CMO. The following ... + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization desired. + Experience… more
- WellSpan Health (York, PA)
- …Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares ... and oversees the operations of the utilization management department. Works with hospital, regional, medical ... Management Committee. + Works closely with Medical Director to identify trends in payor… 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...appeals review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the… more
- Point32Health (Canton, MA)
- …and liaises with the interdisciplinary care team, to improve member outcomes (ie, Utilization Management , Medical Director , pharmacy, community health ... CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care,...ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works… more
- CVS Health (Columbus, OH)
- …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 responds… more
- Point32Health (Canton, MA)
- …- clinical leadership. The Director oversees and leads medical management activities related to precertification utilization management and discharge ... we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing,… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Corewell Health (Grand Rapids, MI)
- Job Summary - Director , Utilization Management The Director , Utilization Management is responsible for providing oversight to the utilization ... to ensure an excellent customer experience. Essential Functions - Director , Utilization Management + Oversees...new technology for use in the Utilization Management area. In conjunction with Medical Operations… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical… more
- Trinity Health (Boise, ID)
- …**Job Description:** Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position ... appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is… 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,...units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review, Commercial inpatient and outpatient behavioral health… 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 ... review. The UM Director is also responsible for the oversight of utilization management auditing, both internal and external, for all DHMSO service areas,… more
- Point32Health (MA)
- …as well as any partner entities at the direction of Behavioral Health Medical Director Team Leader for Utilization Management (UM) and/or the Medical ... Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment reviews for...They will work closely with colleagues in UM and Medical Management , and with other departments as… more
- 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
- Kepro (AR)
- …of the Dental Utilization Management program. + Collaborate with Medical Director on case consultations as needed. + Discuss complicated Utilization ... in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on… more