- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth...in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Zurich NA (Washington, DC)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Elevance Health (Washington, DC)
- …of licensure the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred. + Inpatient ... RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location**...is located at 609 H. Street NE. The **Medical Management Nurse** is responsible for review of the most… more
- Trinity Health (Silver Spring, MD)
- …review, or similar areas. + Extensive understanding of payer mechanisms and clinical utilization management . + Strong interpersonal skills with a track record of ... **Employment Type:** Full time **Shift:** **Description:** **Position Title:** Director , Multi- Complex Acute Care Management **Job Type** : Exempt- Full Time… more
- Trinity Health (Silver Spring, MD)
- … review, or a similar area. + Strong knowledge of payer mechanisms, utilization management , and regulatory requirements. + Proven ability to lead through ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Director of Care Management ** **Holy Cross... develops, organizes, and leads an integrated, hospital-wide care management program to optimize resource utilization , care… more
- Humana (Washington, DC)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Washington, DC)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Washington, DC)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more