- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but are… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for ... (UM) department across the Houston Methodist system. This position oversees all aspects of utilization review to ensure medical necessity, level of care… more
- Fallon Health (Worcester, MA)
- …the cost of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ...for hiring appropriate non-physician clinical and non-clinical personnel to review medical cases and determine if requests… more
- Elevance Health (Indianapolis, IN)
- ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... required by law. Alternate locations may be considered. The ** Medical Director ** is responsible for reviewing cases...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Cleveland, OH)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Insight Global (New York, NY)
- …practice medicine is required. * 3+ years of clinical practice * 2+ years of utilization review experience in a managed care plan (health care industry) referred ... Job Description This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services...* Use correct templates for documenting decisions during case review . * Receive and review escalated reviews.… more