- 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 ... 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 … 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 ... on the hospital campus currently include general surgery, obstetrics and gynecology, internal medicine and transitional year. AdventHealth Tampa is home to 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 ... the LAORA electronic medical record. + Shares on-call responsibility with Medical Director to oversee clinical evaluation and management of potential organ… 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
- 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 ... Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM...Medical Affairs). **Required Qualifications** * Family Medicine or Internal Medicine Board Certification. * Minimum of 5 years… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... Officer. **Required Qualifications** + Doctor of Medicine (MD) - Internal Medicine or Family Practice + **OR** Doctor of...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… 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 role ... utilization, and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...Collaboration + Serve as a liaison and consultant for internal UM functions, promoting effective communication and… 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 ...- Board certification in Family Medicine, General Surgery 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
- 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 ... Medicaid plans in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a "Work from… more