- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care....in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and… more
- Buckeye Community Health Plan (Thornville, OH)
- …functions for the business unit. Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- Monogram Health (Fort Myers, FL)
- …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
- Christus Health (San Antonio, TX)
- …Medicare GMLOS by managing per Milliman/Interqual Care Guidelines. Resource/ Utilization Management /appropriateness: Assess assigned patient population for ... This position provides expertise and leadership to insure effective resource management for patient care delivery (Conditions of Participation COP 482.30). Case… more
- Monogram Health (Jacksonville, FL)
- …suite of technology-enabled clinical services, including case and disease management , utilization management and review , and medication therapy ... care, population health context. They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where… more
- Defense Health Agency (San Antonio, TX)
- …Department or Hospital board or committee meetings. Participates in the clinic Utilization Management and Quality Assurance processes. Attends Continuing Medical ... objectives. The incumbent exercises independent judgment in the medical treatment and management of patients and Internal Medicine Clinic (IMC) with the full range… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …including specimen identifiers and metadata, and ICF-associated permissions prior to utilization .Collaborate with Procurement to review contracts and ensure ... around rare diseases and immune disorders. We are currently seeking a Biosample Management Operations Intern from June 2026 - May 2027. This position will be… more
- Tris Pharma (Monmouth Junction, NJ)
- …of contracting, pricing governance, government compliance, and vendor management . The Director orchestrates complex cross-functional workflows, manages day-to-day ... other payer contracts, including redlining contract language, coordinating cross-functional review and approval workflows, and ensuring execution consistent with… more
- Novo Nordisk Inc. (Minneapolis, MN)
- …policies, legal, regulatory, and compliance requirements Ensures effective administrative management of regional business as well as operational budgets Maintains ... as directed Records all activities within a customer response management system (eg VEEVA) and all expenses within Concur...c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives… more
- Novo Nordisk Inc. (Lubbock, TX)
- …adverse cardiovascular events. Our ambition is to advance broad cardiometabolic disease management by bringing exciting new therapies to market to improve patient ... productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights… more
- Trinity Health (Syracuse, NY)
- …Collaborate with the administrative team to oversee department activities. Manage cost management , utilization review , quality assurance, and medical ... guidelines and assist in policy/procedure development. Oversee clinical peer review , documentation, and care planning. Assist with clinical patient complaints… more
- Eisai, Inc (Boston, MA)
- …Executives to work with downstream regional payer accounts of the national payers. Review and analyze applicable data to make informed decisions on regional payer ... effectively implement those plans at local level. Keep senior management updated on all key issues at account(s) in...closely with Medicaid Director and other cross-functional teams to review and analyze applicable data to make informed decisions… more
- Novo Nordisk Inc. (Irvine, CA)
- …productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- Christus Health (Wake Village, TX)
- …chart peer review , case records review and utilization review as deemed necessary by management . Performs all other duties as assigned. Requirements: ... Education/Skills Masters level degree in speech language pathology is required. Basic Computer Knowledge Ability to communicate effectively, both verbally and in writing. Experience New graduate entry level or any amount of experience in speech therapy is… more
- Christus Health (Leary, TX)
- …chart peer review , case records review and utilization review as deemed necessary by management . Performs all other duties as assigned. Requirements: ... Education/Skills Masters level degree in Speech Language Pathology is required Basic computer knowledge Ability to communicate effectively, both verbally and written Experience New graduate entry level or any amount of experience in speech therapy is… more
- Christus Health (Red Lick, TX)
- …chart peer review , case records review and utilization review as deemed necessary by management . Performs all other duties as assigned. Requirements: ... Education/Skills Masters level degree in speech language pathology is required. Basic Computer Knowledge Ability to communicate effectively, both verbally and in writing. Experience New graduate entry level or any amount of experience in speech therapy is… more
- Interim HealthCare (Greenwood, IN)
- …Registered Nurse (RN) in home health or similar setting; previous case management / utilization review experience preferred. OASIS experience preferred. ... implementation and ongoing assessment of the patient's plan of care through the management of home health aides, LPNs, RNs, and other caregivers. Communicate patient… more
- Butterball (Calypso, NC)
- …maintaining safety culture and ensuring continuous improvement through the utilization of Butterball Operating System Solutions (BOSS). Supports and empowers ... tasks. Participates in HR activities such as hiring, terminations, performance management , goal setting, team member development, scheduling, etc. Enforces systems,… more
- HCA Healthcare - Chief Medical Officer (San Antonio, TX)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- Vista Community Clinic (Vista, CA)
- …technicians and other staff. Participate in quality assurance, quality improvement and utilization review Provide in-service training to clinic staff to increase ... of clinic protocols and procedures to ensure quality medical care Participate in utilization and peer review programs which evaluates the quality of the… more
