- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization Management ... Review for the Enterprise. The individual works in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders to ensure application… more
- CVS Health (Frankfort, KY)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... and the Southeast Region (FL, LA and WV). This Medical Director will be a "Work from...Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or… 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. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… 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...and staff who perform the functions of Utilization Management ( UM ), Case Management (CM), Transition Planning/ Discharge Planning, and… 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 ... **Shift Start Time** **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours** **:** **Shift Start… 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 ... will be engaged in these important projects along with traditional UM activities: Member of the Medical Leadership Team, the group of Medical Directors and… more
- Molina Healthcare (New York, NY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... * Provide regional medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to… more
- Fallon Health (Worcester, MA)
- …appeals review + Member appeals review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology review ... process + Provide support for UM administrative infrastructure + Participate in the HP's strategic planning process and establish yearly financial goals and monitor… more
- The Cigna Group (Bloomfield, CT)
- …solutions. **Essential Functions:** + Ability to manage development and execution of clinical UM strategy. This would include both the ongoing updates to existing ... UM solutions and the evolution of UM ...color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual… more
- Tufts Medicine (Burlington, MA)
- …Overview** The position is responsible for CDI program strategy and oversight. The Director will partner with the Senior Director , Clinical Revenue Cycle to ... multiple revenue cycle and hospital departments, such as Coding, Utilization Management ( UM ), Case Management, Quality and Physician advisors and leaders. The … more