- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... to individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/ corporate - director -of- clinical - utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime… more
- AmeriHealth Caritas (Newtown Square, PA)
- …quality improvement and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice ... Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in… more
- The Cigna Group (Bloomfield, CT)
- …leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate contracting efforts to ensure ... alignment across formulary, utilization management, SafeGuard, and other trend solutions. **Essential Functions:**...Functions:** + Ability to manage development and execution of clinical UM strategy. This would include both the ongoing… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques ... and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with...guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as… more
- Sharp HealthCare (San Diego, CA)
- …medical directors on utilization function. + Identifies physicians whose utilization and/or clinical practices are aberrant and recommends and participates ... **Facility:** Corporate Offices **City** San Diego **Department** **Job Status**...of private practice physicians. **Required Qualifications** + 5 Years clinical practice experience. + California Physicians and Surgeons License… more
- Tufts Medicine (Burlington, MA)
- …and payment processing. In addition, this role focuses on performing the following Utilization duties: Ensures the delivery of clinical services is appropriate ... Medical Center, Melrose Wakefield Hospital, Lowell General Hospital, and our Corporate Headquarters in Burlington, MA. **Job Profile Summary** This role focuses… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Director - Mount Sinai International- Corporate -Full-Time** Mount Sinai International, LLC ("MSI") has created a line of consulting, ... education, training and clinical knowledge transfer services and co-branded products and services...relationships. Reporting to the President, Vice President or Executive Director , Mount Sinai International and working closely with other… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of...represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. **Position Overview:** The Corporate Director , Health Insurance Strategy, is responsible for ... leadership concerning significant data strategy matters to the organization. The Corporate Director will oversee and drive performance data-informed decision… more
- Humana (Honolulu, HI)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more