- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team (UM Nurses/ Medical Director ) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...RESPONSIBILITIES + Monitor incoming faxes + Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS… more
- Centene Corporation (Tallahassee, FL)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… 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
- Centene Corporation (Columbus, OH)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Evolent (Oklahoma City, OK)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- UPMC (Media, PA)
- …Behavioral Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical ... for the clinical needs of Community Care members. The Medical Director also participates in regional leadership...appropriate committees of the PH MCOs. + Reviews the medical aspects of cost and utilization reports… more
- Humana (Indianapolis, IN)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare... Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management… more
- Humana (Topeka, KS)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Blue KC (MO)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, ... and/or requested site of service should be authorized. The Medical Director will apply various clinical policies,...decisions that may not have universal agreement, particularly around utilization review activities. + Review … more