- St. Luke's Health System (Boise, ID)
- …Luke's is truly a great place to work. The **Director of Clinical Review Management ** provides strategic and operational leadership across multiple settings and ... operating units to lead the organization's utilization management function in support of SLHS...: City** _Boise_ **Category** _Nursing Leadership_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_… more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes… more
- RWJBarnabas Health (Newark, NJ)
- …Additionally, candidates must have at least 3 years of recent experience in Case Management , Utilization Review , or Discharge Planning, and a minimum of ... or leadership experience required. This role focuses on clinical resource management , utilization review , discharge planning, and patient advocacy.… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …a plus. Experience: + Minimum 5-10 years of progressively responsible experience in medical management , or utilization review within a healthcare plan, ACO, ... responsible for the strategic direction, leadership, and oversight of all medical management functions, including Utilization Management , and Quality… more
- Evolent (Carson City, NV)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Centene Corporation (Richmond, VA)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + ... Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or… more
- Guthrie (Sayre, PA)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
- CommonSpirit Health (Englewood, CO)
- **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... to all constituents.** **Key Responsibilities** + Conducts medical record review in appropriate cases for medical necessity of inpatient...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more