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Healthcare / Bachelors / Some College Remote Medical Director Utilization Jobs
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California Licensed Utilization Management Nurse
Key Responsibilities Perform medical necessity reviews for an assigned panel of members Collaborate with the Medical Director on adverse determination notices Ensure timely discharge planning and communication to transition of care teams RequiredMassachusetts RN Utilization Management
Key Responsibilities: Conducts utilization review activities for inpatient cases using evidence-based criteria Collaborates with care management and medical directors to facilitate discharge planning and ensure compliance with guidelines MonitorsFlorida Licensed Clinical Review Nurse
Performs concurrent reviews to determine member's overall health and appropriate level of care Reviews quality and continuity of care, including acuity level, resource consumption, and discharge planning Collaborates with healthcare providers and medical...directors to discuss member care and validate medical necessity Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience, with 2+ years of acute care experience requiredVirginia Licensed Medical Director
A company is looking for a Medical Director - Medicaid N. Central.South Carolina Licensed RN Medical Reviewer
A company is looking for a RN Medical Reviewer III to perform medical reviews and support medical claims and utilization practices....activities and provides guidance to team members Required Qualifications Graduate Company an accredited School Company Nursing or an Associate's degree in a related field 2 years Company clinical experience plus 1 year in utilization/medical review, or 3 yearsDirector of Medical Affairs
A company is looking for a Director of Medical Affairs Lead to oversee medical and clinical affairs activities.Medical Director - Medicare Licensed
A company is looking for a Medical Director for the National Medicare Team.Medical Claims Data Analyst
Key Responsibilities Analyze medical claims data to generate insights on cost savings opportunities for self-funded employers Identify trends in medical utilization and provider pricing to support cost reduction strategies Develop geographic coveragePopulation Health Data Analyst
services and subject matter expertise on healthcare quality metrics Required Qualifications Bachelor's degree in a related field or equivalent experience Minimum two (2) years of experience analyzing healthcare quality measure data Experience with medical...claims, utilization, and financial data analysis Preferred experience in a managed care environmentDirector of Acute Care
Key Responsibilities Oversee central acute care operations and market-level Mobile Integrated Care operations Partner with the Acute Care Medical Director to execute operational strategies and expand services Recruit, mentor, and develop team members
