- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements… more
- Humana (Little Rock, AR)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,… more
- Humana (Jefferson City, MO)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- CVS Health (Springfield, IL)
- …will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one ... support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization… more
- UNC Health Care (Morrisville, NC)
- …well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a strategic and operational ... of healthcare resources in alignment with institutional goals. The Executive Director works closely with leaders from various departments-case management, physician… more
- 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 ... supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director ...care experience - Board certification in Family Medicine or Internal Medicine / Pediatrics - Prior UM … 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
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community,...State Fair Hearings as needed and state calls. Understand UM and participate in UM front line… more
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