- Fallon Health (Worcester, MA)
- …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management… more
- Integra Partners (Troy, MI)
- …funded programs; no OIG sanctions + 5+ years of utilization management experience, including complex case review + Prior leadership experience overseeing ... (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions ... The Utilization Review Medical Director is responsible...or past OIG or state sanctions + Experience performing utilization management or clinical review activities +… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests** + **Develop strong ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration...Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
- LifeCenter Northwest (Bellevue, WA)
- …or operational needs. + Collaborate with the Director , Organ Utilization , to manage departmental budgets and identify cost- management opportunities without ... clinical proficiency and participate in on-call schedule as directed by the Director , Organ Utilization , available for consultation outside of regular working… more