- CenterWell (Annapolis, MD)
- …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...ABQAURP, or other boarddemonstratingadvanced training in transitions of care, quality assurance,utilizationmanagementand care coordination. + A current and unrestricted… more
- Centene Corporation (Jefferson City, MO)
- …for members. + Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, ... receive medically necessary, evidence-based care aligned with bet practice promoting safety, quality and cost of care outcomes. Assist the Vice President of Medical… more
- Elevance Health (Richmond, VA)
- …May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare service ... leadership in enhancing training and orientation materials. + May complete quality audits and assist management with developing associated corrective action plans.… more
- Integra Partners (Troy, MI)
- …Experience as a health plan medical director + Experience with DMEPOS UM programs , MLTC, Medicaid, or Medicare Advantage + Experience chairing or ... Strategic and Operational Leadership + Collaborate with the SVP of Operations, UM Director , Credentialing leadership, and other internal teams to drive… more
- Integra Partners (Troy, MI)
- …inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program . + Serve as a clinical resource for UM ... The Utilization Review Medical Director is responsible for conducting clinical reviews of...(DME) and related requests to support Integra's Utilization Management ( UM ) operations. This full-time, salaried role functions within a… more
- CVS Health (Springfield, IL)
- …inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (ie, ... provides clinical oversight and mentorship for CVS Health clinical programs , PBM Clinical Quality activities, consultative support... director will become sufficiently skilled in various UM programs to support other segments (including… more
- UNC Health Care (Morrisville, NC)
- …that includes key statistics that impact the success of the organization and the UM program . 2. **Leading People** - Operational oversight of centralized and ... unique communities we serve. **Summary** : The **Executive System Director of Utilization Management ( UM )** is a...compliance with healthcare regulations, measure the effectiveness of the UM program including length of stay (LOS),… more
- Wellpath (Lemoyne, PA)
- …UM updates and participate in meetings. + Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and ... * Tuition Assistance and dependent Scholarships * Employee Assistance Program (EAP) including free counseling and health coaching *...is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and… more
- Healthfirst (NY)
- …identify areas for improvement** + **Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program , sometimes through the ... requirements** + **Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner** +...subject matter expert on business development efforts related to UM programs , including the launch of new… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for… more