- CVS Health (Springfield, IL)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from Home" position… more
- CVS Health (Trenton, NJ)
- …primarily supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members ... in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from Home" position… 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 ... support for Care Management (CM) departments and serves as a liaison between UM and CM teams and medical staff, as well as, the medical liaison for payor… more
- AdventHealth (Tampa, FL)
- …UM ) and secondary support for Care Management (CM) departments and serves as a liaison between UM and CM teams and medical staff, as well as, the medical ... Management, Care Management, Managed Care and Revenue Cycle departments and applicable medical staff, as well as collaborating with other disciplines to assist in… more
- Commonwealth Care Alliance (Boston, MA)
- 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management ( UM ) and Policy, the Medical ... of health services specific to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership with medical… 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 ... decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider...for accessibility within the network. - Consults with the medical director on cases that do not… more
- University of Maryland, Baltimore (Baltimore, MD)
- The University of Maryland School of Medicine is seeking a Chair and Medical Director of Critical Care for the UM Capital Region Health Medical Center ... Associates, PA They will work closely and in collaboration with the Trauma Medical Director , Chief of Cardiac Surgery, Surgery, Medicine, Neurocritical Care. The… more
- University of Miami (Miami, FL)
- …abdominal organs in approximately 50% of cases. + In conjunction with the Medical Director assumes ultimate responsibility for donor management and the process ... to work in Miami, FL. The Recovery Coordinator 1 ( UM LAORA) assists in the recovery, packaging, preservation and... medical record. + Shares on-call responsibility with Medical Director to oversee clinical evaluation and… more
- Evolent (Trenton, NJ)
- …operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: ... Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing… more
- Cedars-Sinai (Beverly Hills, CA)
- …member eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/Manager/ Director / Medical Director to research any ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors or Management. + Processes… more
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