- Evolent (Olympia, WA)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation,… more
- Evolent (Olympia, WA)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process improvement and enhancement of… more
- Molina Healthcare (Seattle, WA)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Spokane, WA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Seattle, WA)
- …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 (Spokane, WA)
- …Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina Medicare and Medicaid on early ... 2 years in a manager role. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery,… more
- Whidbey General Hospital (Coupeville, WA)
- …issues with other departments as needed. + Ensures completion of admission medical necessity reviews within 24 hours of admission. Completes concurrent inpatient ... medical necessity reviews daily, unless otherwise specified by payer....identification of Avoidable Days and communicates information to executive director of nursing as well as other leadership, as… more
- Providence (Everett, WA)
- …and evaluation of appropriate services and resources to maximize optimum outcomes. The UM Supervisor assists the Washington NWR Director of Care Management in ... not simply valued - they're invaluable. Join our team at Providence Regional Medical Center Everett and thrive in our culture of patient-focused, whole-person care… more