- Northeast Alabama Regional Medical Center (Anniston, AL)
- …with special projects as directed or requested by the supervisor or department director . Performs Concurrent Review for the presence of history and Physical Exam. ... of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of medical… more
- Billings Clinic (Billings, MT)
- …if unsuccessful or unable to resolve issues, escalates to Supervisor, Manager, or Director * Insurance and Utilization Management * Maintains working knowledge ... of CMS requirements and readmission penalties * Maintains working knowledge of insurance/payer benefit * Documents accurately and in a timely manner in the Electronic Medical Record per program guidelines * Utilizes standards of professional practice in all… more
- BrightSpring Health Services (Dunbar, WV)
- …of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure adequate ... with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the day-to-day clinical… more
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/UM of any quality issues.Attends hospitalists rounds, as required, to ... for medical necessity are issued under the direction of the Medical Director or designee.Assists with transfers, when necessary. + Demonstrates knowledge of… more
- Dartmouth Health (Lebanon, NH)
- …**UR specific experience preferred Responsibilities * Works with Medical Director and appropriate physician(s) to establish Dartmouth-Hitchcock (D-H) ambulatory and ... but not limited to, reviewing denial letters, collaborating with the Medical Director and appropriate physicians to determine the decision to appeal or accept,… more
- Providence (Mission Hills, CA)
- …and screens phones. Schedules and coordinates all meetings attended by Administrative Director of Managed Care, Contract Manager, Case Managers and UM supervisors. ... Provides vacation coverage for Executive Administrative Assistant duties as assigned. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person… more
- CVS Health (Columbus, OH)
- …processes in alignment with contract, and implementing cost-effective drug utilization initiatives. + **Regulatory Compliance:** The Pharmacy Director ... it all with heart, each and every day. **Position Summary** The Pharmacy Director for Aetna Better Health OhioRISE will be responsible for all clinical, financial,… more
- Centene Corporation (Salem, OR)
- …a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director for Trillium Community Health Plan, our Oregon market. Candidates will need ... + Must be licensed in Oregon + American Board Certification + Utilization Management experience and knowledge of quality accreditation standards highly preferred… more
- Brockton Hospital (Brockton, MA)
- PURPOSE OF POSITION: The Director of Case Management is responsible for planning, directing, and managing of the activities of the Case Management Program for ... Actively solves problems, referring exceptional issues to Vice President. The Director of Case Management is responsible for planning, directing, and managing… more
- The County of Los Angeles (Los Angeles, CA)
- NURSING DIRECTOR , ADMINISTRATION ( Director , Workforce Management and Operations) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3110377) ... Apply NURSING DIRECTOR , ADMINISTRATION ( Director , Workforce Management and Operations)...and maintain strategic and operational initiatives for nursing workforce utilization . The incumbent will monitor and trend workforce metrics… more