- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …to ensure appropriate coordination of care\. + Seek the advice of the Medical Director when appropriate, according to policy\. + Performing comprehensive ... for letters, retrospective claim review, special review requests, and UM pre\-certifications and appeals, utilizing medical appropriateness criteria,… more
- Katmai (Usaf Academy, CO)
- …records and provides upon request. + Reports monthly summary of care to Director , Medical Management (MM) or designee. + Conducts monthly evaluation, in ... **SUMMARY:** Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions. **ESSENTIAL DUTIES & RESPONSIBILITIES:**… more
- Provider Solutions & Development (Torrance, CA)
- Providence Little Company of Mary is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Torrance, ... develop strong collaborative and positive mutually supported relationships between the medical center and its physicians to improve clinical quality, resource… more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in ... develop strong collaborative and positive mutually supported relationships between the medical center and its physicians to improve clinical quality, resource… more
- CVS Health (Madison, WI)
- …Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses ... that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- Humana (Little Rock, AR)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Providence, RI)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... per month with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... cost-effective care to our members. This role further assists the Senior Medical Director or Chief Medical Officer in execution of strategic clinical… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific...& external sources + Other duties as assigned by UM Director + Strong organizational skills, ability… more
- Elevance Health (Chicago, IL)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefit Management** **Genetic Testing Utilization Management/Review** **Virtual:** This ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- Integra Partners (Troy, MI)
- …& Oversight + Provide day-to-day clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM team. + Ensure consistent, ... clarity + Experience as a health plan medical director + Experience with DMEPOS UM programs, MLTC, Medicaid, or Medicare Advantage + Experience chairing or… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a...workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in… more
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Fallon Health (Worcester, MA)
- …of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for the ... Utilization Management ( UM ) department across the Houston Methodist system. This position...position oversees all aspects of utilization review to ensure medical necessity, level of care appropriateness, and compliance with… more
- Wellpath (Cleveland, OH)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- Elevance Health (Tampa, FL)
- ** Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida...criteria (eg, MCG, InterQual, CMS guidelines). + Collaborate with UM nurses and case managers to review inpatient admissions,… more
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