- Dignity Health (Bakersfield, CA)
- …Group / IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... to work within PST business hours.** **Position Summary:** The Medical Director of UM reports to the...Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... This position works with both inpatient and outpatient Care Management nurses to monitor appropriate care and services in...appeals review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the… more
- WellSpan Health (York, PA)
- …Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares ... and oversees the operations of the utilization management department. Works with hospital, regional, medical ... Management Committee. + Works closely with Medical Director to identify trends in payor… more
- CVS Health (Tallahassee, FL)
- …Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds… more
- Humana (Augusta, ME)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Hartford, CT)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Dover, DE)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Humana (Charleston, WV)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical… more
- Martin's Point Health Care (Portland, ME)
- …managed care experience with progressively increasing responsibilities in medical director capacities, including utilization management and medical ... to Work" since 2015. Position Summary The Health Plan Medical Director provides leadership for the clinical...and executes on all aspects of the health plan's medical policy, clinical utilization management … more
- AmeriHealth Caritas (Newark, DE)
- …initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and the CMO. The following ... + 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization desired. + Experience… more