- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality ... fresh perspective on workplace flexibility. **Position Purpose:** Lead a team of medical directors and supervise MD's responsible for utilization management and… more
- Provider Solutions & Development (Torrance, CA)
- Providence Little Company of Mary is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Torrance, ... You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular...* Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization … more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in ... You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular...+ Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization … more
- Humana (Little Rock, AR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... to our members. This role further assists the Senior Medical Director or Chief Medical ... directors including but not limited to scheduling needed Utilization Management coverage, annual goal development, monthly 1:1s, mentorship/career… more
- Humana (Jefferson City, MO)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
- Elevance Health (Chicago, IL)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefit Management** **Genetic Testing Utilization Management/Review** **Virtual:** ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical… more
- Dignity Health (Bakersfield, CA)
- …reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting ... patient information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. - Bachelors of… more
- CVS Health (Madison, WI)
- …that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- Integra Partners (Troy, MI)
- …+ Provide day-to-day clinical leadership and oversight to the Utilization Review Medical Director (s) and clinical UM team. + Ensure consistent, accurate, ... require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures...+ Experience as a health plan medical director + Experience with DMEPOS UM programs,… more