- Martin's Point Health Care (Portland, ME)
- …Plans. The MD works collaboratively with other plan functions that interface with Medical Management such as Health Management , Compliance and Appeals, ... and internal staff + Willingness to explore innovative methods of providing medical management + Supports the culture and models the MPHC values This position… more
- Humana (San Juan, PR)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more
- Sharp HealthCare (San Diego, CA)
- … functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and ... departments of Health Services to support, provide assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality … more
- The Cigna Group (Bloomfield, CT)
- …+ Participates in coverage guideline development, development and maintenance of medical management projects, initiatives and committees. + Participates in ... be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a managed care… more
- Veterans Affairs, Veterans Health Administration (Milwaukee, WI)
- …the full range of duties described in the target position description. Medical Management Specialist. Responsibilities Promotion Potential: The selectee may be ... during other than normal tours of duty to clinical and administrative medical center staff. Responsible for achieving management objectives and supporting… more
- Centene Corporation (Tallahassee, FL)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... Assist the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit.… more
- UPMC (Media, PA)
- …+ Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. + Acts as a liaison for Community Care with ... a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional ...Community Care members. This includes significant responsibility for quality management and utilization management and for assuring… more
- CVS Health (Tallahassee, FL)
- …member meetings as needed. * Develop and guide the implementation of Medical Management programs to ensure providers deliver appropriate, high-quality, ... resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management , clinical… more
- The Cigna Group (Atlanta, GA)
- …communication with matrix partners including but not limited to, Claims Operations, Medical Management . Credentialing, Legal, Medical Economics, Compliance, ... **Work Location: Atlanta, GA** The **AVP, Provider Contract Network Management ** serves as an integral member of the Network...position. + Identify and manages initiatives that improve total medical cost and quality. + Drives change with external… more
- Centene Corporation (Richmond, VA)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy procedures… more
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