424 medical director utilization management jobs found

POSITION SUMMARY/RESPONSIBILITIES This position provides clinical leadership and oversight of the population health management program including utilization management, case management, preventive health/disease management, and quality management while supporting the multidisciplinary member-centric approach to care management. Actively participates with staff across the organization - this is essential to facilitate integrated service delivery, planning, quality assurance, and risk management and to address the needs of members and their families to protect and promote the healthcare of members. EDUCATION/EXPERIENCE A medical degree as Doctor of Medicine (MD) or Osteopathy (DO) and an active and unrestricted Texas Medical License, free of sanctions from Medicaid or Medicare is required. Minimum of five year of direct clinical patient care experience post-residency is required. Minimum two years' experience in a medical leadership role is preferred. Previous experience...

Physician Advisor - Sentara Obici Hospital (Suffolk, VA) Make a broader impact beyond patient care and help shape healthcare delivery at Sentara Health. As a Physician Advisor, you'll leverage your clinical expertise to influence patient outcomes, support physician engagement, and drive quality, compliance, and operational excellence while partnering with physicians and leaders across the health system. The On-Site Physician Advisor at Sentara Princess Anne Hospital in Virginia Beach, Virginia , conducts timely and compliant medical necessity reviews and assists with denials management, including peer-to-peer discussions and appeal letters, in support of Sentara's centralized Utilization Review (UR) process. The Physician Advisor plays a critical role in ensuring appropriate patient status determinations, supporting compliant billing practices, and strengthening collaboration among Clinical Revenue Cycle, Utilization Review, Integrated Care Management (ICM), hospital...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Contributes to the Hospital’s mission by supporting proper classification and a safe plan of care. This professional licensed position will have an impact on finance and growth by classifying patients’ status appropriately and supporting the workflow and care plan to ensure the delivery of high quality, safe patient care while maintaining an expected length of stay within budget. This role is critical to the denial management, utilization review, and discharge planning process and will support the evolution towards a system approach in this realm. This role functions in a high integrity manner and as a case management and utilization expert, collaborating interdepartmentally to educate and improve processes to appropriate classify patient status, which ultimately improves reimbursement. The Utilization Management Specialist will impact the patient experience and...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

Location Detail: 80 Seymour Street (10008) Assistant Medical Director of Hospital Medicine Hartford HealthCare (HHC) is the largest integrated health care system in Connecticut and includes seven hospitals, a large multi-specialty medical group, the largest behavioral health network in Connecticut, senior care services and a rehabilitation network. We offer a clinically advanced and stimulating work environment in which to grow your career. Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We are in search of a Assistant Medical Director to join our Hospital Medicine team at Hartford Hospital. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford Hospital: As directed by the Hospital Medicine Division Director, the Assistant Director (AD) will act as a member of the leadership team joining the Practice...

R09874 Operating Room Background Required. CNOR preferred. The Director of Surgical Services is responsible for planning, organizing and directing of the operations and staff (clinical and non-clinical) of the Surgical Services Department. This position serves as a key member of the leadership team and will participate in strategy, goal setting and is responsible for overall operational effectiveness of the areas of responsibility. The Director of Surgical Services operates as a key member of the hospital leadership team, developing and implementing strategy to deliver optimal nursing care. He/She directs and ensures continuous quality and safety of staff and patients and improvement of all clinical practices, services and operations by managing the design and implementation of systems, processes and methods to evaluate and improve safe patient care across the continuum. Responsbilities: Operate as a key member of the hospital leadership team, developing and implementing...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

Your future role at a glance Location: Baltimore, MD Facility Name : Ascension Saint Agnes Hospital Schedule: Full-Time Base salary: $407,359 - $612,013 per year Productivity incentives: RVU Sign-on bonus and relocation assistance CME allowance + dedicated CME days Malpractice coverage with tail This job location is not currently located in a Health Professional Shortage Areas (HPSAs) for Primary Care and/or Medically Underserved Areas/Populations (MUA/P) Shortage Designation Type . Life at Ascension: Where purpose meets opportunity Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and...

Become a part of our caring community As a Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you will lead and support a team of dedicated clinicians who deliver compassionate, high quality care in the home setting. By guiding clinical practice, coordinating patient services, and ensuring excellence in every step of the care journey, you'll empower patients to achieve their highest level of independence while helping your team thrive in their roles. As a Registered Nurse Clinical Manager , you will: Oversee clinical operations for the location, including patient care delivery, staff management, documentation quality, and regulatory compliance, working onsite in-office. Review referrals, determine admission appropriateness, assign clinicians, and ensure Plans of Care meet patient needs and agency standards. Guide, support, and educate clinicians; help goal set, care planning, and clinical decision making; and remain available during operating...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Day (United States of America) Job Summary: The RN House Supervisor is a registered professional nurse who provides hospital wide leadership to all departments and divisions through the effective use of advance competencies in communication, job knowledge, professionalism and business skills to promote the creation of a center of excellence for staff recruitment and retention, and in clinical and business outcomes.This leader is a member of the leadership team and is responsible for overseeing...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset - we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting...

Director of Nursing role in our Cherry Hill, NJ surgery center will be work clinically and aministratively. You must have supervisory experience as you will oversee the nursing staff. Center hours are Monday through Friday 8:30am to 5:00pm with some flex on start time. Sign On Bonus Quarterly Bonus Opportunity! Excellent benefits: Medical, dental, vision, paid maternity & paternity leave, vision, 401K w/ match, PTO, tuition assistance, life insurance, Long Term and Short Term disability, Flexible Spending for Healthcare, Dependent Care & Commuter Expenses PURPOSE AND SCOPE: Works with the Facility Manager, facility staff and physician to coordinate the facility operations and patient procedures to ensure provision of quality patient care on a daily basis in accordance with organization policies, procedures and training. Provides nursing support to patients and staff. Assist with staffing, staff training, equipment, physician and patient relations, cost...

PURPOSE AND SCOPE: Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory requirements and programs. Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of care and patient and staff safety PRINCIPAL DUTIES AND RESPONSIBILITIES: Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing. Provides leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with...

Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: UPC Inpatient Adult Services FTE: 1.00 Full Time Shift: Days Position Summary: Direct and coordinate the clinical and management activities of one or more unit (s) in order to provide quality patient care. Actively supports programs and services that are in line with long-range strategic objectives. Support education and research in conjunction with Unit Medical Director. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include neonate, pediatric, adolescent, adult and geriatric age groups. Detailed responsibilities: SUPERVISION - Plan, coordinate and direct activities of supervisory, technical professional and support staff; conduct staff meetings MANAGE - Interview applicants, hire, train, supervise, evaluate,...

$ 48.43/hr. Maximum Offer $ 75.10/hr. Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: Intermediate Critical Care FTE: 1.00 Full Time Shift: Days The director of the Intermediate Critical Care (ICC) will take part in setting up a brand-new unit for a growing service line. The director of this unit will have a unique opportunity to work with a specialized and complex population and will work hand in hand with critical care leadership to establish high quality patient centered care for the people of New Mexico and beyond. Position Summary: Direct and coordinate the clinical and management activities of one or more unit (s) in order to provide quality patient care. Actively supports programs and services that are in line with long-range strategic objectives. Support education and research in conjunction with Unit...

Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: Neuroscience ICU FTE: 1.00 Full Time Shift: Days UNM Health provides the highest quality of care for more than 200,000 New Mexicans each year. In 1952, UNM Hospital was built on Native American grounds, with the promise to provide culturally competent and inclusive care to all New Mexicans. UNM Health is New Mexico's only Level I Trauma Center-we care for patients with the most complex conditions from across the state. Additionally, we are the first NIH-designated Comprehensive Cancer Center and award-winning Advanced Care Stroke Center. UNM Health providers specialize in over 150 areas of medicine and employ over 7,000 professionals. Together, we receive 900,000 outpatient visits, 22,000 surgical cases and 100,000 emergency room visits each year. Position Summary: Direct...

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: Emergency Room - SRMC FTE: 1.00 Full Time Shift: Nights Position Summary: Work under the general nursing process while using independent judgment to assign nurses, technicians and nursing care to assigned patients. Designate shift and schedule assignments, call in staff, send staff home and monitor attendance. Provide clinical leadership for nursing and technician staff. Ensure adequate staff to meet patient census. Supervise staff and patient care delivery on designated shift, and serve as a clinical resource for staff. Serve as a role model to promote a positive work environment and quality patient care. Ensure adherence to Hospitals and departmental policies and procedures. Patient...