- 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 quality ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Fallon Health (Worcester, MA)
- …of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation… more
- Magellan Health Services (Albuquerque, NM)
- …to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health ... utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- University of Miami (Coral Gables, FL)
- …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Executive Director of the Office of Research Administration ... and management of ORA's mission for the Coral Gables, Rosenstiel, and Medical Campuses for Pre-award, Post-award, and the Strategic Initiatives divisions. The… more
- University of Miami (Miami, FL)
- …institutions of higher education in the US for its academic excellence, superior medical care, and cutting-edge research. At the U, we are committed to attracting ... to create an environment where everyone contributes to making UM a great place to work. We are one...Overview:The Philanthropy Officer is responsible for planning, developing, and managing the fundraising strategies and initiatives to support the… more
- University of Michigan (Ann Arbor, MI)
- …and with Michigan Medicine policies. Works closely and effectively with the Administrative Director for Medical Staff Services, the Chief Medical Officer, ... At least 5 years' experience in management with supervisory experience + Experience managing a Medical Staff Office (MSO), Credentialing and Privileging Office,… more
- CareFirst (Baltimore, MD)
- …alignment with direction established through thought partnership with the Director of UM and the VP/CMO of Medical Management.Ability to use proper change ... work across multiple business areas, collaborate with peers, clinical, clinical support, medical director , and other levels while ensuring alignment with… more
- University of Miami (Miami, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of Miami/UHealth Medical Training Lab at the Gordon Center is ... currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami,...per year. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more