Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. Critics have argued if cost cutting by insurers is the focus of their use of UM criteria, it could lead to healthcare rationing by overzealous denial of care as well as retrospective denial of payment, delays in care, or unexpected financial risks to patients.
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It's more than a career, it's a calling. OK-REMOTE. Worker Type. Regular. Job Highlights. This RN selected for this role is required to have a compact state nursing license as they will provide cross coverage for MO / WI/ OK admissions. Prior experience in Utilization Review is required. Job Summary. Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to s...
Job Summary. We are seeking a highly experienced and strategic Medical Director - Physician to serve as our Supervising Physician in accordance with state regulatory requirements and ensure the delivery of exceptional patient care. The ideal candidate will possess extensive knowledge of healthcare management, clinical research, and regulatory compliance. This leadership position requires a physician with strong management skills, expertise in EMR...
Job Summary. Priority Health is seeking a. Medical Director. This position is critical to Priority Health's mission of improving health, inspiring hope and saving lives as we partner with medical communities. Expectations will include: A strong understanding of the guiding principles of. Right care, Right time, Right place, Right cost. This strong understanding of the guiding principles will be demonstrated through applications of evidence-based ...
Job Summary. Priority Health is seeking a. Medical Director. This position is critical to Priority Health's mission of improving health, inspiring hope and saving lives as we partner with medical communities. Expectations will include: A strong understanding of the guiding principles of. Right care, Right time, Right place, Right cost. This strong understanding of the guiding principles will be demonstrated through applications of evidence-based ...
Job Description Summary The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards. How will you make an impact & Requirements **This is a remote position. however, candidates located in CA, N...
Job Number. 25-6473 / 25-12568. Job Summary. The primary functions of this position are utilization management, conducting utilization reviews, granting authorizations, and monitoring compliance with and for various contracts entered into by Integral Care and Tejas Behavioral Health. Contracts include, but are not limited to, those with departments of the State of Texas, the City of Austin, Travis County, and managed care health plans. Calls comi...
Overview. Greenleaf Behavioral Health Hospital is a 113-bed behavioral health and substance use disorder (SUD) treatment hospital located in the heart of South Georgia. We offer inpatient hospitalization, partial hospitalization, and intensive outpatient programming for adolescents, teens, and adults struggling with depression, anxiety, bipolar disorder, behavioral issues and mental health issues. . We are seeking dedicated Director of Utilizatio...
Location. Based in Forest Hills, PA (15221), covers all Community LIFE locations. Schedule. 7:30am-4:00pm Mon-Fri with flexibility in schedule to respond to emergent needs. Summary of Job Duties. The Utilization Review Manager (URM) directs and manages the utilization management functions of all responsible staff. In consultation with the Director of Nursing Services, the URM develops and implements policies and procedures for utilization managem...
ABOUT THIS TEMP POSITIONThis is a part-time temporary position, and the length of the assignment is estimated to go from December to March with the possibility of extension. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.The time commitment for this position i...
ABOUT THIS TEMP POSITIONThis is a part-time temporary position, and the length of the assignment is estimated to go from December to March with the possibility of extension. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.The time commitment for this position i...
ABOUT THIS TEMP POSITION. This is a part-time temporary position, and the length of the assignment is estimated to go from December to March with the possibility of extension. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. The time commitment for this positio...
ABOUT THIS TEMP POSITIONThis is a part-time temporary position, and the length of the assignment is estimated to go from December to March with the possibility of extension. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.The time commitment for this position i...
