- Scottish Rite for Children (Dallas, TX)
- …committed to giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
- Trinity Health (Silver Spring, MD)
- …/supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related ... RN with BSN or RN with > 10 years case management experience. Masters Degree preferred. **Minimum...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of… more
- Sharp HealthCare (San Diego, CA)
- …experience or case management experience + 3 Years recent case management , utilization review, care coordination experience + California Registered ... performance planning, competency and individual development planning process.Maintain current knowledge of case management , utilization management , and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...of services and approved claims. + Oversees retrospective reviews, case appeals, billing coordination, and clinical support. + Ensure… more
- AnMed Health (Anderson, SC)
- …and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at AnMed. The Medical Director ensures the program and ... The Utilization Review Medical Director supports operations...the leadership and staff who perform the functions of Utilization Management (UM), Case … more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan +… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This...MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position… more
- Covenant Health (Nashua, NH)
- …of the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... and quality of care and communicates findings to the director of the department. + Maintains current knowledge of...Minimum of five years broad clinical experience preferred + Case management and/or Utilization … more
- Henry Ford Health System (Detroit, MI)
- …DNB numbers 2. Ensure correct patient status for hospitalized patients 3. Chair Utilization Management Committee: a. Reviewing outlier data, observation LOS b. ... The Medical Director of Utilization Review is responsible...of Stay (LOS) escalations; a. Respond to escalations from case management , RNs, residents, staff, etc. b.… more