- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Director of Utilization Review is responsible for overseeing all utilization review activities to ensure that clients ... for each client. This individual leads a team of utilization review specialists and works closely with...medical necessity for all levels of care provided. The Director also supports and maintains strong collaboration with facility… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... a week. + **Hospital:** Ascension Saint Thomas + **Location:** Remote - Nashville, TN. This position requires occasional travel...in the TN market. We're looking for an experienced Director of Utilization Management to join our… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Health Plan members. This fully remote role will be responsible for assuring physician commitment...Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- Insight Global (Boston, MA)
- Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... fall within the Clinical Performance, Operations, and Innovation organization. The Director is responsible for providing strategic guidance to the business, ensuring… more
- AmeriHealth Caritas (Dover, DE)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Centene Corporation (Olympia, WA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Evolent (Santa Fe, NM)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple… more
- Ochsner Health (New Orleans, LA)
- …(2) Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty ... Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such certifications +… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual review of the Utilization … more