- Trinity Health (Boise, ID)
- …Saint Alphonsus is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This position will be ... annually by the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation , and Utilization ... Management programs at AnMed. The Medical Director ensures the program and associated physicians work collaboratively with and provide consultation to the… more
- ERP International (Nellis AFB, NV)
- …employing team building concepts in both multi -and inter-disciplinary setting to maintain medical and utilization management goals. Must be able to provide oral ... and present medical care practices for patterns; trends incidents of under-or over- utilization of resources incidental to providing medical care. * Acts as… more
- Sharp HealthCare (San Diego, CA)
- …venues.Escalate and refers cases for consultation with Medical Director as appropriate.Oversee preparation, delivery and documentation of non-coverage ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care… more
- Guthrie (Binghamton, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. a) Serves ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at ... healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral health… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations of… more
- Sharp HealthCare (San Diego, CA)
- …Care Coordinator level of review.Appropriately identify claims for review by the Medical Director to include obtaining the appropriate medically necessary ... the eMD for and forward the claim with all applicable information to the Medical Director . + Quality and Productivity Performance Achieve 90% or greater… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a...for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for… more
- Hartford HealthCare (Torrington, CT)
- …Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry Patient ... Care Team to assure Utilization Review activities on a 17 bed Adult unit....promote the individualized care plan. * Maintains timely patient-centered documentation that reflect the patient and client systems' pertinent… more