Director Optum Utilization Review Jobs in Raleigh, NC

... to Director when needed. Screens all cases against high risk screens for discharge planning ... One year utilization and review experience. Experience with MCG authorization criteria preferred.

... to Director when needed. Screens all cases against high risk screens for discharge planning ... One year utilization and review experience. Experience with MCG authorization criteria preferred.

... to Director when needed. Screens all cases against high risk screens for discharge planning ... One year utilization and review experience. Experience with MCG authorization criteria preferred.

Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Direct: 732-549-5302

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Works with Medical Affairs and/or Medical Directors as needed to discuss member care being ... Assists with providing education to providers on utilization processes to ensure high quality ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...

The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...

As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

About The Role The Medical Director performs utilization review and medical necessity determinations for BHPS-administered self-funded commercial plans, and supports the Chief Medical Officer in ...

... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...

Provides clinical leadership, including directing treatment plans, participating in on-call coverage, advising multidisciplinary staff, and supporting utilization review efforts. * Serves as a key ...

Leads evaluation of public health programs, quality assurance, utilization review, and ... Advises Health Director on emerging occupational health needs and compliance issues.

Leads evaluation of public health programs, quality assurance, utilization review, and ... Advises Health Director on emerging occupational health needs and compliance issues.