- Molina Healthcare (GA)
- …Licensure. JOB DESCRIPTION Job Summary Leads and directs a multidisciplinary team of healthcare services professionals in some or all of the following functions: ... one or more of the following key health care services functions: care management, utilization management, care...clinical services . * Collaborates with and keeps healthcare services senior leadership informed of operational… more
- Prime Healthcare (Inglewood, CA)
- … that are appropriate to the hospital mission and patient/family needs. The Director of Case Management ntegrates and coordinates services using continuous ... core values of quality, compassion, and community. As a member of Prime Healthcare , a Top-15 hospital system in the United States, Centinela Hospital Medical Center… more
- Alameda Health System (Oakland, CA)
- …guidance, training, and performance evaluations. + Monitor and evaluate the utilization of healthcare services , including appropriateness, efficiency, ... Director , Utilization Management + Oakland, CA...Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations.… more
- Wellpath (Lemoyne, PA)
- …efforts to ensure quality patient care and the appropriate utilization of medical services . The Medical Director of Utilization Management serves as a ... benefits varies based on employee type and length of service . **Why Us** **Now is your moment to make...care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees… more
- Commonwealth Care Alliance (Boston, MA)
- …experience in health plan environment with responsibility for managing the effective utilization of healthcare services , case / disease management, ... Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term… more
- Tufts Medicine (Burlington, MA)
- …health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers ... the design, development, implementation, and monitoring of the organization's utilization review functions. The position establishes the department's strategy and… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management, provides organizational leadership in the operational areas of appeals, utilization review, ... and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford Macomb ... or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing...around the world. We offer a full continuum of services - from primary and preventative care to complex… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …authorization experience preferred. Experience in a Psychiatric setting. Knowledge of healthcare service delivery systems, and third party reimbursement. ... of West Houston. We have highly qualified caring staff ready to provide exceptional service . The team at Houston Behavioral Healthcare Hospital strives to be the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards ... service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members'...procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes… more