- 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
- Ochsner Health (New Orleans, LA)
- …and comply with Federal and State regulations/quality initiatives. Reports to the System Medical Director of Utilization . This job description is a ... Utilization Management experience (preferred) + Familiarity with: Current medical literature, Healthcare reimbursement issues (eg, medical necessity, levels… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Management/ Utilization Management (QM/ UM ) Plan, including having the BH Medical Director for Children's Services and participate on the BH committees ... of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has...rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management ( UM /CM) staff working with… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for...as a RN, preferably in a hospital setting + Utilization management experience in a health plan UM… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and ...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Centene Corporation (Dover, DE)
- …Quality Improvement:** + Provide medical expertise in the operation of utilization management ( UM ) programs and quality improvement initiatives to ensure ... + **Transactional UM Reviews and Complex Case Management:** + Conduct medical reviews for utilization management, including the assessment of medical… more
- Intermountain Health (Murray, UT)
- …Health division as needed to implement policies and programs for the Office of the Medical Director to manage the provider panel and to maintain high customer ... management system. + Committees: Represent SelectHealth on committees as assigned by the Medical Director . + Delivery Improvement: Serve as a resource for the… more
- Molina Healthcare (Seattle, WA)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Sharp HealthCare (San Diego, CA)
- …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... + Provides professional leadership and direction to the functions within the Medical Management + Department ( Utilization /Cost Management and Quality Management)… more
- Molina Healthcare (Dayton, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more