- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the...critical to the success of our members and the Utilization Management ( UM ) department in realizing its… more
- Intermountain Health (Las Vegas, NV)
- …utilization management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, ... in partnership with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines...be engaged in these important projects along with traditional UM activities: Member of the Medical Leadership… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively...the leadership and staff who perform the functions of Utilization Management ( UM ), Case Management (CM), Transition… more
- Ascension Health (Nashville, TN)
- …market. Must be located with in the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...optimize patient care and partner with the National Senior Director of UM to align on organizational… more
- The Cigna Group (Bloomfield, CT)
- …for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate contracting efforts to ensure ... alignment across formulary, utilization management, SafeGuard, and other trend solutions. **Essential Functions:**...+ Ability to manage development and execution of clinical UM strategy. This would include both the ongoing updates… more
- LA Care Health Plan (Los Angeles, CA)
- …safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations ... Supervisor, Utilization Management RN Job Category: Clinical Department: ...LA Care's culturally diverse membership. The position supports the UM Manager/ Director . This role also assists … more
- Catholic Health Initiatives (Houston, TX)
- …to maintain effective team leadership and oversight. This role supports the UM Director in ensuring efficient operations with all processes, policies, ... **Responsibilities** The Utilization Management ( UM ) Manager is responsible...stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require… more
- AdventHealth (Altamonte Springs, FL)
- …which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. **The expertise and experiences you'll ... **The role you will contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is...physician advisor to avoid concurrent denials. 8) Collaborates with medical staff, nursing staff, payor, and ancillary staff to… more
- Beth Israel Lahey Health (Burlington, MA)
- …patients admitted to the Clinic Attending Physicians: Coordinates appropriate documentation Medical Director for /Managed Care, Physician Advisors Works ... taking a job, you're making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for… more
- Commonwealth Care Alliance (Boston, MA)
- … staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... decisions and organizational determinations. Essential Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization… more