- VitalCore Health Strategies (Hopkinton, MA)
- …supervisory services are rendered. Must satisfy all credentialing requirements of VitalCore. Utilization Management experience. Must have minimum of 5 years ... clinical quality indicators, patient safety chart and site audits. Adherence to Utilization Management (UM) programs specific to the contract requirements and… more
- VitalCore Health Strategies (Munising, MI)
- …clinical quality and integrity of patient medical care including oversight of utilization and quality management , credentialing, and best practice guideline ... (VCHS), an industry leader in correctional healthcare, has an opening for a Hub Director - Upper Regional Medical Director - Upper Peninsula , Michigan! The HUB … more
- One Medical (San Francisco, CA)
- …care services, on-site labs, and programs for preventive care, chronic care management , common illnesses and mental health concerns have been delighting people for ... that make One Medical unique. As an Office Medical Director , you'll have the chance to lead your local...priorities. You will be able to continually develop your management and leadership skills as you learn about our… more
- Campbell County Health (Gillette, WY)
- …and contracted patients, under the supervision of the Rehab Supervisor and Director of Rehab. The ST develops and implements individualized, patient-centered therapy ... in patient record that which reflects skilled treatment, time billed and accurate utilization of CPT codes Develops an age-appropriate plan of care which addresses… more
- VitalCore Health Strategies (Ogden, UT)
- …administration/related field. Licensed Registered Nurse. Minimum of two (2) years of management experience in a healthcare setting necessary. Subject to initial and ... interview process for potential staff including necessary collateral colleagues (ie, Director of Nursing) and departments. Interfaces with VitalCore Human Resources… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | Eagan, Minnesota Career Area: Health Services ... difference, join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is responsible for the design, strategic… more
- Fallon Health (Worcester, MA)
- … to identify and prioritize the cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director to set agenda related to UM ... strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care,… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Healthfirst (NY)
- …to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
- Wellpath (Freehold, NJ)
- …for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
- Huron Consulting Group (Chicago, IL)
- …regulatory agencies, and hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with hospital ... review staff and function for the system, reporting to the Director of Utilization Management within Revenue Cycle. Assists with leading recruiting,… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Humana (Raleigh, NC)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Baton Rouge, LA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Dignity Health (Bakersfield, CA)
- …, remote patient monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- Ventura County (Ventura, CA)
- …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
