- Houston Methodist (Houston, TX)
- …and strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is ... At Houston Methodist, the Sr Director Case Management position is responsible for providing...initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes,… more
- Elevance Health (Miami, FL)
- ** Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida...and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets.… more
- CVS Health (Nashville, TN)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals… more
- Centene Corporation (Raleigh, NC)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... of performance improvement initiatives for network providers. + May assist Chief Medical Director in planning and establishing goals and policies to… more
- Humana (San Juan, PR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent (Carson City, NV)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization ... drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan … more
- Elevance Health (Lima, OH)
- ** Medical Director -Long Term Support and...state or territory of the United States when conducting utilization review or an appeals consideration and ... health, behavioral health, long term services and supports, and psychosocial needs._ The ** Medical Director -Long Term Support and Services- MyCare OHIO** is… more
- Brockton Hospital (Brockton, MA)
- …delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare ... management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required.… more
- Corewell Health (Grand Rapids, MI)
- Job Summary Priority Health is seeking a Medical Director . This position is critical to Priority Health's mission of improving health, inspiring hope and saving ... guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound... process and application of sound clinical judgement. The medical director will be part of the… more