- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …PAY RANGE: LVN/LPT $31.50-37.50 Per Hour RN/LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as ... monitor and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further… more
- Ascension Health (Milwaukee, WI)
- …initiatives. + Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time, Partially Remote...strategic direction and oversight of the day-to-day operation of utilization management function within the insurance plan. + Ensure… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... optimal patient level of care, and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the Director for … more
- Elevance Health (Durham, NC)
- …may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be responsible ... ** Utilization Management Medical Director - NC Medicaid**...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- UTMB Health (Friendswood, TX)
- …trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review /Case Management. + Maintains a documentation ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,… more
- Elevance Health (Dearborn, MI)
- …Coast time zone hours.** The **Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... **Medical Director - Commercial** Location: This role enables associates to...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more