- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , ... UPMC Health Plan members. They will oversee adherence to quality and utilization standards through committee delegations and further establish an effective working… more
- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but… 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 ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Centene Corporation (Richmond, VA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy… 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...UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement… more
- Centene Corporation (Olympia, WA)
- …quality accreditation standards. + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Centene Corporation (Phoenix, AZ)
- …fresh perspective on workplace flexibility. **Position Purpose:** Assist the Sr Behavioral Health Medical Director to direct and coordinate the medical ... and credentialing functions for the business unit. + Provides medical leadership of all for utilization management,...initiatives for capitated providers. + Assists Sr Behavioral Health Medical Director in planning and establishing goals… more
- Centene Corporation (Indianapolis, IN)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Evolent (Phoenix, AZ)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization ... drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan … more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Director Medical Affairs Operations- Medical Staff Services -Full-Time -Days ( Remote )** _Our flexible remote opportunities offer ... balance as well as decrease annual commuting expenses_ The Director , Medical Affairs Operations, serves as a... work and preferably have experience working in a remote environment._ Non-Bargaining Unit, 542 - HSO Medical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities,… more
- Magellan Health Services (Albuquerque, NM)
- … data. Strong verbal and written communications skills. General Job Information Title Director , Clinical Care Services - New Mexico, Remote Grade 30 Work ... This is a remote position supporting New Mexico. Candidate needs to...in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical… more
- Mount Sinai Health System (New York, NY)
- …** Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days - Remote ** The Director , Pre Appeals Management is a strategic ... and coordination of care to improve patient outcomes while controlling costs. The Director collaborates closely with medical staff, vendors, case management, and… more
- AmeriHealth Caritas (Washington, DC)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring… more
- Intermountain Health (Las Vegas, NV)
- …I leads and collaborates with care management operations across utilization review, acute and emergency department care, and ambulatory/community settings, ... at various care sites within a market or region, working collaboratively with medical staff, nursing, clinical, and revenue cycle leaders to optimize patient care… more
- Evolent (Annapolis, MD)
- …LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- South Middlesex Opportunity Council (Framingham, MA)
- …children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must ... Long-Term Disability for full-time employees. + Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing… 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 ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...with authorization requests + Contact requesting providers to obtain medical records or other necessary documentation related to specific… more