- Fallon Health (Worcester, MA)
- …among the nation's top health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, ... summary of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic… more
- Integra Partners (Troy, MI)
- The Senior Medical Director (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. ... Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application...Support and guide internal audits, inter-rater reliability programs, and clinical quality monitoring. + Serve as the… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The **Program Director (Licensed)** is responsible for leading and sustaining a Utilization Management Initiative supporting ACO and ... value-based care populations. This role drives cost-effective, high- quality post-acute care through strategic partnerships, data-driven performance oversight, … 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 ... staff, department chairs, hospital leadership, and finance teams to harmonize utilization management practices, ensuring alignment with clinical and financial… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical...hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high- quality patient care.… 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 ... clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and Medicaid… more
- Wellpath (Cleveland, OH)
- …staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management ... care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees... of Utilization Management leads and oversees utilization review, case management, quality improvement, and… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... by law. Alternate locations may be considered. The **Medical Director ** is responsible for reviewing cases for IN Medicaid...be responsible for developing and implementing programs to improve quality , cost, and outcomes. May provide clinical … more
- Centene Corporation (Richmond, VA)
- …and champions change within scope of responsibility + Partner closely with claims and clinical and non- clinical Utilization Management (UM) team members to ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Prime Healthcare (Inglewood, CA)
- …our dedicated team of professionals are committed to our core values of quality , compassion, and community. As a member of Prime Healthcare, a Top-15 hospital ... for 100 years. An award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is...to BCBSMN customers and for assuring members receive high quality and appropriate clinical care in a… more
- Insight Global (New York, NY)
- …and Responsibilities * Provide timely medical reviews that meet Oscar's stringent quality parameters. * Provide clinical determinations based on evidence-based ... clinical reviews. * Collaborate with other departments on Utilization Management Operations. * Lead key projects and drive...to practice medicine is required. * 3+ years of clinical practice * 2+ years of utilization … more
- Healthfirst (NY)
- …and regulatory requirements + Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner + Ensure UM operations ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality / Utilization Review Nurse Position Summary: The Quality / Utilization Review Nurse is responsible for evaluating the medical necessity, ... in the electronic health record (EHR). o Prepare reports for leadership on utilization patterns, denials, quality metrics, and infection control outcomes. *… more
- LifeCenter Northwest (Bellevue, WA)
- …optimal transplant outcomes. Admin and Quality Responsibilities + Partner with the Director , Organ Utilization to develop, track, and report on clinical ... other recovery teams as needed. + Serve as a clinical resource for Organ Utilization Coordinator Team...of allocation and logistics processes, make recommendations to the Director , Organ Utilization and/or the Quality… more
- Magellan Health Services (Albuquerque, NM)
- …Care Services - New Mexico, Remote Grade 30 Work Experience - Required Clinical , Management/Leadership, Quality , Utilization Management Work Experience - ... providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical...+ Leads and organizes the ongoing evaluation of the utilization management program against quality and … more
- CommonSpirit Health (Phoenix, AZ)
- …to high-level organizational decision-making, working closely with other executives and clinical leaders to align utilization management practices with overall ... cost-control strategies that reduce unnecessary medical expenses while maintaining high- quality care. Monitor utilization trends and identify opportunities… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …performing utilization management activities. The goal is to achieve clinical , financial, and utilization goals through effective management, communication, ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work onsite.… more
- UTMB Health (Webster, TX)
- …care (inpatient, outpatient, emergency and infirmary care) with the goal of enhancing quality clinical outcomes, promoting timely access to medical care, and ... as needed. + Participates in research activities/projects + Provides assistance regarding clinical issues to non-nursing utilization review staff + Demonstrates… more
- Genesis Healthcare (Hayward, CA)
- … management of the rehab department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient ... therapists, consideration of clinical requirements, and recommendations from the Clinical Director . 12. Administers financial controls of revenue and… more