- Humana (Phoenix, AZ)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the ... 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 … more
- Humana (Phoenix, AZ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... 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 … more
- Humana (Phoenix, AZ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Molina Healthcare (Phoenix, AZ)
- …HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous ... leadership experience + Peer review, medical policy/procedure development, and provider contracting experience + Current clinical knowledge + Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and… more
- Sevita (Tucson, AZ)
- …DSPs in documenting incident reports; submits initial incident reports to the Program Director . 8. Billing and Utilization : Compiles or accumulates census or ... on a daily basis; maintains 3. Program Planning: Assists the Program Director in development of individual program plans; trains and monitors implementation of… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... organization's goals and objectives for assuring the effective, efficient utilization of health care services. This role will be...required. + Minimum 7 years of experience in a director level, or equivalent leadership role, required. + Prior… more
- Dignity Health (Mesa, AZ)
- **Job Summary and Responsibilities** Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective ... utilization review to support and encourage the efficient and...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is… more
- Cognizant (Phoenix, AZ)
- …Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, ... background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience… more
- Molina Healthcare (Tucson, AZ)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Phoenix, AZ)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more