- CenterWell (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...data requires an in-depth evaluation of variable factors. The Medical Director relies on medical … more
- Humana (Phoenix, AZ)
- **Become 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 work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Phoenix, AZ)
- …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 ... other weekend with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing… more
- Molina Healthcare (Mesa, AZ)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Scottsdale, AZ)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... * Provide regional medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to… more
- Molina Healthcare (Tucson, AZ)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- CVS Health (Scottsdale, AZ)
- …and best practices in the development and maintenance of programs supported by Medical Affairs, drives the regulatory strategy of UM programs and supports ... efficiencies. + Manage the maintenance and external requests of Medical Affairs UM Policies and Procedures. +...across organization by supporting all Heartbeat page maintenance throughout Medical Affairs. + Work with the Lead Director… more
- CommonSpirit Health (Phoenix, AZ)
- …regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental ... + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational goals and regulatory standards.… more
- Evolent (Phoenix, AZ)
- …participate in meetings as assigned with practices and/or payers. Will work with the Director of UM to ensure client satisfaction. Perform all peer clinical ... under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the...with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of… more
- Datavant (Phoenix, AZ)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more