- AdventHealth (Altamonte Springs, FL)
- …contribute:** The Physician Advisor provides primary support for Utilization Management ( UM ) and secondary support for Care Management (CM) departments and serves ... as a liaison between UM and CM teams and medical staff, as well...submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and… more
- AdventHealth (Tampa, FL)
- …**:** The Physician Advisor provides primary support for Utilization Management ( UM ) and secondary support for Care Management (CM) departments and serves ... as a liaison between UM and CM teams and medical staff, as well as, the medical liaison for payor escalations. The Physician Advisor is responsible for educating,… more
- CVS Health (Springfield, IL)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals)… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management ( UM ) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... drive day to day operations and oversight of the UM program. + Lead, develop and manage processes to...provide guidance to assist in operational questions and/or escalated UM cases from delegates, Care Partners, Providers, and internal… more
- Fallon Health (Worcester, MA)
- …policies and standards; problems lacking clear precedent are usually reviewed with the Director , UM and PA prior to taking action. **Responsibilities** **Primary ... members. + Attends FH committee meetings as assigned by the Director of UM and PA, such as TruCare Production meetings, Authorization Automation development… more
- CVS Health (Springfield, IL)
- …regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" ... Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center (UMCRH), ... PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The Chair will be… more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from Home" position ... primarily supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members and… more
- Commonwealth Care Alliance (Boston, MA)
- 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management ( UM ) and Policy, the Medical Policy ... services specific to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership with medical leadership… more
- CommonSpirit Health Mountain Region (Salt Lake City, UT)
- …for maintaining a collaborative partnership with the Medical Director CDI, Enterprise Director Case Management, UM Hub Director , and Care Coordination ... position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination teams to ensure correct patient status,… more
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