- Commonwealth Care Alliance (Boston, MA)
- 023520 Clin Alli-Physicians Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the ... Utilization Review Medical Director will be responsible for providing leadership and subject...for providing leadership and subject matter expertise to our utilization management ( UM ) group. This role is… more
- Wellpath (Lemoyne, PA)
- …resources for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees ... patient care and the appropriate utilization of medical services. The Medical Director ...admissions. + Evaluate and recommend policy improvement related to utilization reviewsystem, andprovide UM updates and participate… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- Integra Partners (Troy, MI)
- …policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting ... The Utilization Management ( UM ) Nurse Supervisor is...with DMEPOS authorization and appeals processes. + Knowledge of medical necessity criteria (InterQual, CMS, health plan policies). +… more
- CommonSpirit Health (Phoenix, AZ)
- …will be an expert on matters regarding physician practice patterns, over and under- utilization of resources, medical necessity, levels of care, care progression, ... **Essential Key Responsibilities:** + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational… more
- LA Care Health Plan (Los Angeles, CA)
- …admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- Humana (Lansing, MI)
- …for Humana's dual eligible members. + Serves as a liaison between Humana utilization management ( UM ) operations and the State of Michigan regarding prior ... of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...logs and other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and… more
- ERP International (Barksdale AFB, LA)
- …practices as needed for patterns, trends, orincidents of under or over utilization of hospital resources incidental to medical careprovided to beneficiaries. ... Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, LA **Be the Best!** Join...and other health team members. Submits all concerns through Utilization Management Director ; be able to identify,… more
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