- 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...internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,… more
- Humana (Jefferson City, MO)
- …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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … 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)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... to our members. This role further assists the Senior Medical Director or Chief Medical ...Department of Certifying Board Services required + Certification in Internal or Family Medicine specialty preferred + Current state… more
- Integra Partners (Troy, MI)
- …position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are not limited to: Clinical ... day-to-day clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM ...Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams… 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 ... to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with… 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
- 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 ... supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director ...- Board certification in Family Medicine, General Surgery or Internal Medicine / Pediatrics - Prior UM … 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 ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation...Represents the Vice President and Senior Medical Director of Clinical Management at internal and… 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …/Cost Protection * Accountabilities include the overall value of utilization management ( UM ) product, medical and reimbursement policies, and maintenance of ... characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan,… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community,...State Fair Hearings as needed and state calls. Understand UM and participate in UM front line… more
- Magellan Health Services (Albuquerque, NM)
- …to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health ... utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and… 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
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- University of Miami (Coral Gables, FL)
- …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 ... please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Executive Director of the Office of Research Administration (ORA) reports… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our ... plan. In this key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services… more
- University of Michigan (Ann Arbor, MI)
- CLINICAL NURSING DIRECTOR (CS Mott Children's Hospital: 10-West Pediatric Cardiothoracic Intensive Care Unit- PCTU) Apply Now **Job Summary** The Pediatric ... from state, regional, national, and international referrals. PCTU specializes in the medical and surgical care of infants, children, adolescents, and adults with… more