- CHRISTUS Health (Alamogordo, NM)
- …and reporting individual cases and/or trends to the infection control nurse. Performs utilization management functions as required by payer source. Complies with ... appeals in a timely manner, upon request by the Director . Initiates discharge planning on assigned patients within 24...the Utilization Management Plan. Requirements Education Required: Associate… more
- Marion County (Salem, OR)
- …SUPERVISION RECEIVEDWorks under the general supervision of a Health Department Division Director who assigns and oversees work, establishes goals and reviews results ... to the following Program Development & ManagementProvide program development and management /oversight of a diverse group of programs and teams. Program oversight… more
- Universal Health Services (Streamwood, IL)
- Responsibilities Director of Utilization Management Full-Time The Director of Utilization Management is responsible for the oversight of the ... utilization management department. Responsibilities include monitoring team members to initiate...and implementation of discharge planning and customer service. The Director will analyze data to track trends including length… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/160505/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the CommonSpirit Health Care… more
- Ascension Health (Baltimore, MD)
- …Ascension Saint Agnes is seeking a dynamic and experienced Director of Case Management & Utilization Management . In this position you will play a ... **Details** + **Department:** Case Management & Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint… more
- Geisinger (Harrisburg, PA)
- …Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of ... provide effective and meaningful educational programs across the department. Responsible for management of the Utilization Review policy and observation … more
- Ascension Health (Austin, TX)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and claims processing. + Oversee work with provider relations on resolving issues. + Manage… more
- Elevance Health (Columbus, OH)
- **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Universal Health Services (San Antonio, TX)
- …Standards, providing on-site education to manage difficult cases, and assisting the Director of Utilization Management with department processes and ... procedures. Key Responsibilities: + Maintains knowledge of all facets of Utilization Management + Supports Director and performs management duties when … more
- Mirror (Newton, KS)
- Job Summary: Under the administrative supervision of the Director of Utilization Management , the URC is responsible for the implementation, and maintenance ... and departmental guidelines. + Other duties as requested by the Director of Utilization Management . Qualifications + High School diploma or equivalent… more
- AdventHealth (Maitland, FL)
- …The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related to inpatient care, ... assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends to… more
- CVS Health (Springfield, IL)
- …to Account Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and ... Management in support of Key Clients as assigned.The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and… more
- Humana (Columbus, OH)
- … 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
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director , the Supervisor of Utilization Management is responsible ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- Universal Health Services (Colorado Springs, CO)
- … Management Care Coordinator opportunity available, this position reports to the Director of Utilization Management . Schedules vary. About the Position: ... (attached) with a current resume and turn it in to Susan Chambers, Director of Utilization Management , Human Resources or the reception desk on the first… more
- Nuvance Health (Norwalk, CT)
- …including discharge planning, utilization management and high-risk case management . Works collaboratively with the Director of transitions to ensure ... State and Federal Regulations relative to Discharge Planning, Utilization Management and Continuum of Care. Director Care Coordination- Major… more
- AmeriHealth Caritas (Newark, DE)
- …and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the ... (SMO) experience preferred. + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization… more
- YesCare Corp (Hanover, MD)
- …Shares information gathered at the quarterly area multidisciplinary CQI Committee meetings with the Utilization Management Medical Director to be used at the ... setting. + At least 2 years of clinical operations management experience required preferably within a correctional health setting....is a list of your responsibilities as a **Statewide Director of Nursing** with YesCare: + Participates in the… more
