- AdventHealth (Altamonte Springs, FL)
- …contribute:** The Physician Advisor provides primary support for Utilization Management ( UM ) and secondary support for Care Management (CM) departments and serves ... as a liaison between UM and CM teams and medical staff, as well...submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and… more
- AdventHealth (Tampa, FL)
- …contribute:** The Physician Advisor provides primary support for Utilization Management ( UM ) and secondary support for Care Management (CM) departments and serves ... as a liaison between UM and CM teams and medical staff, as well as the medical liaison for payor escalations. The Physician Advisor is responsible for educating,… more
- CVS Health (Springfield, IL)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals)… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management ( UM ) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... drive day to day operations and oversight of the UM program. + Lead, develop and manage processes to...provide guidance to assist in operational questions and/or escalated UM cases from delegates, Care Partners, Providers, and internal… more
- CVS Health (Springfield, IL)
- …regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" ... Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers… more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from Home" position ... primarily supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members and… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- Commonwealth Care Alliance (Boston, MA)
- 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management ( UM ) and Policy, the Medical Policy ... services specific to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership with medical leadership… more
- CommonSpirit Health Mountain Region (Salt Lake City, UT)
- …for maintaining a collaborative partnership with the Medical Director CDI, Enterprise Director Case Management, UM Hub Director , and Care Coordination ... position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination teams to ensure correct patient status,… more
- Dignity Health (Bakersfield, CA)
- …information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to obtain appropriate ... decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider...accessibility within the network. - Consults with the medical director on cases that do not meet the established… more