- UpvoteDownvoteShare Job
- Suggest Revision
The Behavioral Health Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
The position includes close collaboration with the treatment team, which may include a Psychiatrist, Psychiatric Resident, Psychiatric Advanced Practice Nurse, Physician Assistant, Mental Health Counselor, Patient Care Technician, and Psychiatric Nurse.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Experience in a health plan or Physician Organization environment with Care Coordination, Utilization Management, disease management, and/or population health. Our focus is to support physician offices in all aspects of care delivery and operations including clinical integration, contracting, quality, care coordination and care management, across all settings.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Emergency services and/or utilization review/case management experience preferred. A Minimum three years of clinical nursing, case management and/or utilization review experience.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. Provides information for pricing guidelines based on utilization patterns and client demographics.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Associates degree, diploma or B.S. in Nursing Three to Five (3-5) years recent experience in an acute-care environment, case-management or utilization management position (experience can be a combination of LVN/RN licensure) Previous HEDIS and/or CMS STARs experience a plus Role requires working onsite at providers office.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Supports the VP of CM with completion of financial analyses including cost of care to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization, clinical documentation/queries quality care and patient safety; oversees the Inpatient recovery process; works closely with Revenue Cycle and AHS Physician Advisors; regularly communicates with payors and/or their contracted vendors.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Case Manager/RN Navigator is responsible for the comprehensive assessment, planning, implementation, and evaluation of individual patient needs for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, procedures and standards.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Ability to do C-arm and X-ray images Vast experience with pain management procedures (ESI, fluoroscopy guided joint injections) and orthopedics HIGHLY RECOMMENDED. Knowledgeable of local, state, federal and Joint Commission Regulations.
Part-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Become a part of our caring community and help us put health first. Advanced degree such as an MBA, MHA, MPH. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in their daily work. Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business.
ExpandApply NowActive JobUpdated 3 days ago
utilization management physician jobs
FEATURED BLOG POSTS
How to Conduct a Performance Review (With Examples)
In a world where the smallest mistake can cost your business tens of thousands in lost revenue, your talent is key to keeping your edge on the market and driving growth. However, managing a workforce of any size can be a challenge. Employees come with their own particular skill set, ambitions and flaws. So, it can be difficult to uncover their individual drivers. Not to mention the challenges brought on by the hybrid and remote working models where in-person interactions have become few and far between.
How to Recruit Passive Candidates
Learning to recruit passive candidates is a different ballgame than recruiting active ones. While an active candidate is someone who is currently looking for a new job, a passive candidate tends to be the opposite. Passive candidates are either already working or not looking to work. So, instead of these candidates coming to you, you'll have to find them and reach out to them first.
How to Effectively Recruit Employees
Today, hiring and retaining talent looks much different than it did only two or three years ago. Financial instability and the strain on our mental health brought on by the pandemic has made everyone more wary and selective of their workplace and employer. Whereas in the past people might have prioritized promotions and financial reward, today they look at other factors such as workplace flexibility, personal fulfillment and values alignment.
How Many Hours is Part-Time vs. Full-Time Work?
Growing up you watched your parents shuffle to and from the office, held hostage to their 9 to 5. If jammed-packed schedules and deadlines sound frightening, you might consider pivoting your search to part-time jobs. In fact, even employers have shifted their preference, selecting more people open to the idea of flexible working hours.
How to Make a Job Offer More Competitive
Money alone makes it hard to attract and retain top-notch candidates, especially when you are competing with larger businesses and corporations in your industry. So, instead of focusing on money, figure out how to make a job offer more competitive when you can't offer more money.
5 Ways to Stretch Your Hiring Budget
Many businesses across the country have adjusted business operations to make it through the pandemic. After a period of hardship, many business owners, like yourself, are ready to start recruiting and rebuilding a bigger, more skilled workforce - only now you have to do it with a smaller hiring budget.
How to Ask for a Raise at Work
Here we go again; it’s time to talk money. Whether you’re one year in at a new company or approaching year five on the same team, learning how to ask for a raise should be part of your long-term career plan. These conversations are rarely fun (thanks to society, which has conditioned us to believe that money is taboo), but they are necessary if you want to, well, get paid what you’re worth. Trust us, there’s a lot of money on the table for taking. Below, we’ll discuss tips on timing, approach, and follow-up.