- 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
- CVS Health (Springfield, IL)
- …with heart, each and every day. **Position Summary:** The ABHIL Chief Psychiatrist (Senior Medical Director ) will serve as a strategic and operational partner to ... including critical success factors, metrics, and targets. Collaborating with the Medical Management stakeholders both internally ( UM /CM, Pharmacy, Quality,… more
- Dartmouth Health (Lebanon, NH)
- …Inpatient psych UM experience preferred Responsibilities * Works with Medical Director and appropriate physician(s) to establish Dartmouth-Hitchcock (D-H) ... Overview Utilization Review Per Diem - Remote Works with...not limited to, reviewing denial letters, collaborating with the Medical Director and appropriate physicians to determine… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... week. + M-F 8:30am - 5pm. + From the Manager: -Experience: Hospital experience, UM experience -Description: office work, at a desk 8 hours per day, reading clinical… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management ( UM ), and Community Care. Completes 4-6 ... Nurse Manager is accountable to the Consolidated Patient Account Center (CPAC) Director , manages RUR Assistant Nurse Managers, RUR Nurses, and general schedule (GS)… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …clear path toward Chief Medical Officer responsibilities\.** **This is more than a medical director role\. It's an opportunity to shape the future of care ... experienced clinical leader to join our team as Lead Medical Review Director -a pivotal role with a...and serve on various committees in order to accomplish medical utilization , cost and quality objectives of… more
- Humana (Springfield, IL)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... and strategic management of behavioral and physical health services, including Utilization Management ( UM ), Quality Improvement, and value-based payment… 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 (Layton, UT)
- …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
- Blue KC (MO)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, ... level of care, and/or requested site of service should be authorized. The Medical Director will apply various clinical policies, state and federal guidance,… more