- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application of ... clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities...OIG sanctions + 5+ years of utilization management experience, including complex case review +… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director ...or past OIG or state sanctions + Experience performing utilization management or clinical review ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- CenterWell (Boston, MA)
- … Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care received by members in an ... practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more
- Houston Methodist (Houston, TX)
- …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...initiatives. + Provides strategic vision and execution for case management and utilization review across… 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
- Humana (Juneau, AK)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director -Care Management Are you exceedingly driven, dedicated, and passionate about caring for your patients? Do you consistently create and nurture… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical… more
- Elevance Health (Atlanta, GA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- Elevance Health (Las Vegas, NV)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
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