- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review ... + Provide medical expertise in the operation of approved quality improvement and utilization management programs in...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Provider Solutions & Development (Torrance, CA)
- Providence Little Company of Mary is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Torrance, ... relationships between the medical center and its physicians to improve clinical quality , resource utilization and increase value while maintaining and improving our… more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Mission ... between the medical center and its physicians to improve clinical quality , resource utilization and increase value while maintaining and improving mission… more
- Centene Corporation (Jefferson City, MO)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in delivering medical, people ... leadership and expertise to ensure the delivery of high- quality , cost-effective care to our members. This role further...our members. This role further assists the Senior Medical Director or Chief Medical Officer in execution of strategic… more
- Dignity Health (Bakersfield, CA)
- …authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting turnaround times and ... and collaborating with internal departments to coordinate patient care. - Quality & Cost-Effectiveness: Adhering strictly to utilization management policies to… more
- Community Health Systems (Franklin, TN)
- …and enhance usability. + Participates as SME in the training and education programs for clinical staff, ensuring Training Materials are effective for the use of ... and management for the specialty area. + Participates in quality improvement initiatives, leveraging data and analytics to drive...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- Sharp HealthCare (San Diego, CA)
- …discharge or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, ... SRS primary care physician, and ancillary staff to ensure cost effective quality service throughout the continuum of care. **Required Qualifications** + Other :… more
- Integra Partners (Troy, MI)
- …Experience as a health plan medical director + Experience with DMEPOS UM programs , MLTC, Medicaid, or Medicare Advantage + Experience chairing or ... Strategic and Operational Leadership + Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams to drive… more
- Integra Partners (Troy, MI)
- …inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program . + Serve as a clinical resource for UM ... The Utilization Review Medical Director is responsible for conducting clinical reviews of...(DME) and related requests to support Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a… more
- UNC Health Care (Morrisville, NC)
- …that includes key statistics that impact the success of the organization and the UM program . 2. **Leading People** - Operational oversight of centralized and ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a...compliance with healthcare regulations, measure the effectiveness of the UM program including length of stay (LOS),… more
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