- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. ... hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management ...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... Serve as the lead for CCA's Utilization Review functions working closely with other medical management...+ Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed… more
- Integra Partners (Troy, MI)
- …Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, ... the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case...the UR Medical Director . The UR Medical Director will review the case and may… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... Utilization Management and Review for...Utilization Management and Review for the Enterprise. The...and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role… more
- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- LifePoint Health (Gallatin, TN)
- Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays. ... Reports to: Director - Case Management Minimum Education Associate's,...or related healthcare field. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Mgmt Case Manager FT* **Location:** *Tennessee-Gallatin*… more
- Commonwealth Care Alliance (Boston, MA)
- … Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a ... Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible...for overseeing and managing the daily operation of the Utilization Management Review Nurse and… more
- Elevance Health (Los Angeles, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... - 5pm CST, this position includes weekends. The Med Mgmt Nurse CA is responsible for review ...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… more
- Select Medical (Mesa, AZ)
- …and Care Planning Management , Fiscal Management and Payer/Referral Management , Utilization Review . The Director of Case Management is also ... allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and… more
- Sharp HealthCare (San Diego, CA)
- …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
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