- Tenet Healthcare (Detroit, MI)
- Group Utilization Review Director - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... and most diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director , Utilization Review will perform the functions… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, in partnership… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of-case-management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... functions for assigned sites. + Collaborate with the director to develop and implement quality review ...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management ... policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques… 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...3. Sets goals with individual team and as a group 4. Oversees, validates, and directs the daily assignment… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- HCA Healthcare (Brentwood, TN)
- …we encourage you to apply for our Director of Physician Resource Group opening. We promptly review all applications. Highly qualified candidates will be ... is incentive eligible. **Introduction** Do you have the career opportunities as a ** Director of Physician Resource Group ** you want with your current employer?… more
- The Cigna Group (Bloomfield, CT)
- …review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical ... state or territory of the United States as a utilization review doctor of medicine or doctor...on our employee benefits programs, visit Life at Cigna Group . **About Evernorth Health Services** Evernorth Health Services,… more
- Katmai (Fort Carson, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...Ability to effectively communicate and collaborate with a diverse group of people for the purpose of informing the… more