- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current polices to meet ... and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective review … more
- Highmark Health (Pittsburgh, PA)
- …and civil law related to insurance fraud and advances in the post-payment utilization review process + Comprehensive knowledge of legal and investigative ... execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and investigation… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... PURPOSE OF POSITION: The Director of Case Management is responsible for planning,...management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
- Centene Corporation (Indianapolis, IN)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Sharp HealthCare (San Diego, CA)
- …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… more
- Evolent (Jackson, MS)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director … more
- AdventHealth (Altamonte Springs, FL)
- …Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality assurance related to ... activities and program development + Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and… more
- Evolent (Dover, DE)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- UPMC (Media, PA)
- …and serves as a backup for other business units + Advises the Regional Director on the development and review of programs, positions, and budgets having ... (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical Director is responsible… more