- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management ( UM ) and Policy, the Medical ... services specific to the population serviced by CCA. The Medical Policy Director is an independent contributor...(nice to have):** + 10 years of experience in medical policy, utilization management, clinical program leadership… more
- AdventHealth (Altamonte Springs, FL)
- …assists in drafting and submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and ... will contribute:** The Physician Advisor provides primary support for Utilization Management ( UM ) and secondary support for...Management (CM) departments and serves as a liaison between UM and CM teams and medical staff,… more
- AdventHealth (Tampa, FL)
- …role you'll 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,...teams Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization … more
- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Responsible to coordinate with contracting to ... for accessibility within the network. - Consults with the medical director on cases that do not...information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management ( UM ) experience strongly preferred. -… more
- CVS Health (Springfield, IL)
- …that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- CVS Health (Trenton, NJ)
- …Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Medicaid plan and the UM team. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- Evolent (Trenton, NJ)
- …LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...region. Key Responsibilities + Leadership & Management**: + Oversee Utilization Management ( UM ) across assigned hospitals, ensuring… more
- Tufts Medicine (Burlington, MA)
- …remote. May require occasional travel to local facilities including Tufts Medical Center, Melrose Wakefield Hospital, Lowell General Hospital, and our Corporate ... Professional Group (TMPG) . Tufts Medicine Integrated Network (TMIN) . Tufts Medical Center . Lowell General Hospital . MelroseWakefield Hospital, Lawrence Memorial… more