- Provider Solutions & Development (Torrance, CA)
- Providence Little Company of Mary is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Torrance, ... You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular...* Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization … more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in ... You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular...+ Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization … more
- Humana (Sacramento, CA)
- … 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
- Humana (Sacramento, CA)
- …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 ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
- Dignity Health (Bakersfield, CA)
- …reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting ... patient information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. - Bachelors of… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... Utilization Management Nurse Specialist RN II Job Category:...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group… more
- Sharp HealthCare (San Diego, CA)
- …for medical necessity are issued under the direction of the Medical Director or designee.Assists with transfers, when necessary. + Demonstrates knowledge ... or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, as required,… more
- Molina Healthcare (CA)
- …the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … 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