- Rady Children's Hospital San Diego (San Diego, CA)
- …team of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with the ... with full benefits with a remote work option. The Medical Director , UM is a...UM is a clinical subject-matter expert for the Utilization Management Team and shall assist in the oversight… more
- Dignity Health (Bakersfield, CA)
- …Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed. - Ensure compliance with turnaround times and ... to ensure all elements are compliant with established guidelines. - Consults with the medical director on cases that do not meet the established guidelines for… more
- CVS Health (Springfield, IL)
- …that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... **Job Title:** **Registered Nurse UM II** **Location: Columbia SC 29229** **Duration: 3+...3+ month's Contract** **Job Description:** + Reviews and evaluates medical or behavioural eligibility regarding benefits and clinical criteria… more
- Evolent (Frankfort, KY)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet...patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care… more
- Humana (Lansing, MI)
- …**Reporting Relationship:** This position reports directly to the Behavior Health Lead Medical Director . **Requirements:** . BCBA-D with Florida licensure or ... medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work assignments involve moderately… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... patient care and the appropriate utilization of medical services. The Medical Director ...admissions. + Evaluate and recommend policy improvement related to utilization reviewsystem, andprovide UM updates and participate… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management, the role of the...critical to the success of our members and the Utilization Management ( UM ) department in realizing its… more
- Intermountain Health (Las Vegas, NV)
- …utilization management, care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are responsible, ... in partnership with MG Clinical Leadership, for the appropriate utilization of medical services within established guidelines...be engaged in these important projects along with traditional UM activities: Member of the Medical Leadership… more
- Humana (Louisville, KY)
- …of medical services and/or benefit administration determinations. The Associate Director , Utilization Management Nursing requires a solid understanding of ... community and help us put health first** The Associate Director , Utilization Management utilizes clinical nursing skills...Notice of Action is followed including collaboration with the Medical Director to ensure reason for denial,… more