Comprehensive knowledge of and ability to participate in and oversee: • Case Management and Disease Management • Clinical Quality and Continuous Quality Improvement • Utilization Management ...
Comprehensive knowledge of and ability to participate in and oversee: • Case Management and Disease Management • Clinical Quality and Continuous Quality Improvement • Utilization Management ...
Job Summary Manages prospective and concurrent Utilization Management (UM) programs including prior ... This position reports to the Director of UM and coordinates with Case Management (CM) and Care ...
Job Summary Manages prospective and concurrent Utilization Management (UM) programs including prior ... This position reports to the Director of UM and coordinates with Case Management (CM) and Care ...
Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions about the ... Prepares and presents more complex cases for Medical Director Review. Refer cases to Case ...
Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions about the ... Prepares and presents more complex cases for Medical Director Review. Refer cases to Case ...
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
New
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
New
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
New
The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review ... Refer complex or non-compliant cases to Physician Advisors or Medical Directors as appropriate
New
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Utilization Review Manager
Phoenix, AZ · On-site
... management including, but not limited to: utilization review, case documentation, payer ... A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
Hematologist-Oncologist Senior Medical Director of Utilization Management needed to join a practice in Tucson, AZ. This position is with a group that is committed to providing quality services in ...
Hematologist-Oncologist Senior Medical Director of Utilization Management needed to join a practice in Tucson, AZ. This position is with a group that is committed to providing quality services in ...
Director/Management Posting #: 1048096 Employee Type: Full-Time Position Summary This position is ... Manages and evaluates the effectiveness of Case Management and Utilization Management systems and ...
Director/Management Posting #: 1048096 Employee Type: Full-Time Position Summary This position is ... Manages and evaluates the effectiveness of Case Management and Utilization Management systems and ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... Director of Case Management as needed. Also responsible for obtaining insurance authorization for patients in the hospital, coordinating patient care as it relates to referrals and obtaining ...
... management and guidance across health care service systems to include Inpatient / Outpatient ... Works with the Executive Director, Deputy Director, Medical Director, and others to develop ...
... management and guidance across health care service systems to include Inpatient / Outpatient ... Works with the Executive Director, Deputy Director, Medical Director, and others to develop ...
Job Summary The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million ...
Job Summary The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · On-site +1
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · On-site +1
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
Phoenix, AZ · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Medical Director
Phoenix, AZ · On-site
$192.86 - $199.75/hr
Medical Director - Surgery, Orthopedics & PM&RRole Summary Are you an accomplished physician leader ... This physician executive role focuses completely on utilization management, medical necessity ...
Medical Director
Phoenix, AZ · On-site
$192.86 - $199.75/hr
Medical Director - Surgery, Orthopedics & PM&RRole Summary Are you an accomplished physician leader ... This physician executive role focuses completely on utilization management, medical necessity ...
Director Utilization Management information
What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
What is a Director Utilization Management job?
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
What are the typical daily responsibilities of a Director Utilization Management?
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
What are the most commonly searched types of Utilization Management jobs in Arizona? The most popular types of Utilization Management jobs in Arizona are:
What are popular job titles related to Director Utilization Management jobs in Arizona? For Director Utilization Management jobs in Arizona, the most frequently searched job titles are:
- Independent Contractor Remote Utilization Management Nurse
- Hospice Care Cna
- Assistant Director Healthcare
- Director Of Online Education Remote
- Executive Director Healthcare
- Healthcare Revenue Cycle Manager
- Flexible Cvs Utilization Management Nurse
- Remote Utilization Management
- Cvs Health Utilization Management Remote
- Director Of Nursing
What job categories do people searching Director Utilization Management jobs in Arizona look for? The top searched job categories for Director Utilization Management jobs in Arizona are:
What cities in Arizona are hiring for Director Utilization Management jobs? Cities in Arizona with the most Director Utilization Management job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 9 days ago
Job description
We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Oversees and participates in clinical quality reviews, peer review, and provider interactions. Works closely with and oversees clinical staff reviewing potential quality issues and appropriateness of care. Develops provider and system-based corrective action plans as needed. Chairs and coordinates quality and other committee meetings as assigned. Documents reviews of clinical quality and appropriateness of care in the medical management system. Collaborates with VA, military treatment facility and network providers, and TriWest staff to assure timely, appropriate and high quality care. Uses data to facilitate and optimize the delivery of health care services. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction.
Education & Experience
Required:
• MD or DO degree obtained from an institution accredited by the Liaison Committee on Medical Education and listed in Association of American Medical Colleges
• Board Certified by a recognized MD or DO specialty board or proven training to meet board eligibility requirements
• Current unrestricted license to practice medicine in a state or territory of the United States
• 5+ years' medical practice experience
• Subject to a credentialing process to verify licensure, board certification, and standing with HHS and NPDB
Preferred:
• TRICARE, Veterans Affairs, or other government health plan experience
• Advanced management degree (MPA, MBA, MHA, MPH)
• Actively practicing in specialty. Flexible schedule to accommodate practice
• 2+ years' Managed Care experience
Key Responsibilities
• Provides program guidance and clinical oversight for Medical Management programs.
• Engages in peer to peer discussions with network providers and others.
• Reviews potential quality issues for corrective action.
• Reviews member cases for appropriateness of care.
• Participates in internal, external, and joint quality and safety meetings.
• Provides clinical consultation to staff, as needed, especially RN and other nursing staff.
• Provides oversight for clinical decisions impacting beneficiaries.
• Possesses knowledge of medical practice standards and conducts research, as needed, on new technologies and treatments.
Competencies
Coaching / Training / Mentoring: Actively fosters desired business outcomes through ongoing constructive feedback to others.
Communication / People Skills: Collaborates with and Influences others in both positive and negative circumstances. Adapt to different personalities and behavioral styles. Listens critically.
Computer Literacy: Uses computer hardware and software to effectively research, analyze, and document critical functions.
Coping / Flexibility: Understands and commits to goals and embraces the ideas of others to achieve success.
Independent Thinking / Self-Initiative: Thinks critically with ability to focus on things which matter most to achieving outcomes. Exhibits commitment to tasks to achieve key outcomes without direction. Creatively finds solutions to problems and obtains necessary resources to solve them.
Team-Building / Team Player: Influences the actions and opinions of others in a positive manner. Accepts feedback and incorporates it into actions. Builds group commitment.
Technical Skills: Ability to work in a matrix environment. Proficiency in Microsoft Office applications. Comprehensive knowledge of and ability to participate in and oversee:
• Case Management and Disease Management
• Clinical Quality and Continuous Quality Improvement
• Utilization Management, health care cost containment, and Managed Care practices
• URAC Standards and process and other accreditation standards as needed
• HIPAA regulations and requirements
Working Conditions
Working Conditions:
• Regular daytime hours with availability to work additional non-regular hours as needed
• Standard office environment, with limited to moderate travel
• Extensive computer work with prolonged sitting
• Security clearance may be required
Company Overview
Taking Care of Our Nation's Heroes.
It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!
Our job is to make sure that America's heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Oversees and participates in clinical quality reviews, peer review, and provider interactions. Works closely with and oversees clinical staff reviewing potential quality issues and appropriateness of care. Develops provider and system-based corrective action plans as needed. Chairs and coordinates quality and other committee meetings as assigned. Documents reviews of clinical quality and appropriateness of care in the medical management system. Collaborates with VA, military treatment facility and network providers, and TriWest staff to assure timely, appropriate and high quality care. Uses data to facilitate and optimize the delivery of health care services. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction.
Education & Experience
Required:
• MD or DO degree obtained from an institution accredited by the Liaison Committee on Medical Education and listed in Association of American Medical Colleges
• Board Certified by a recognized MD or DO specialty board or proven training to meet board eligibility requirements
• Current unrestricted license to practice medicine in a state or territory of the United States
• 5+ years' medical practice experience
• Subject to a credentialing process to verify licensure, board certification, and standing with HHS and NPDB
Preferred:
• TRICARE, Veterans Affairs, or other government health plan experience
• Advanced management degree (MPA, MBA, MHA, MPH)
• Actively practicing in specialty. Flexible schedule to accommodate practice
• 2+ years' Managed Care experience
Key Responsibilities
• Provides program guidance and clinical oversight for Medical Management programs.
• Engages in peer to peer discussions with network providers and others.
• Reviews potential quality issues for corrective action.
• Reviews member cases for appropriateness of care.
• Participates in internal, external, and joint quality and safety meetings.
• Provides clinical consultation to staff, as needed, especially RN and other nursing staff.
• Provides oversight for clinical decisions impacting beneficiaries.
• Possesses knowledge of medical practice standards and conducts research, as needed, on new technologies and treatments.
Competencies
Coaching / Training / Mentoring: Actively fosters desired business outcomes through ongoing constructive feedback to others.
Communication / People Skills: Collaborates with and Influences others in both positive and negative circumstances. Adapt to different personalities and behavioral styles. Listens critically.
Computer Literacy: Uses computer hardware and software to effectively research, analyze, and document critical functions.
Coping / Flexibility: Understands and commits to goals and embraces the ideas of others to achieve success.
Independent Thinking / Self-Initiative: Thinks critically with ability to focus on things which matter most to achieving outcomes. Exhibits commitment to tasks to achieve key outcomes without direction. Creatively finds solutions to problems and obtains necessary resources to solve them.
Team-Building / Team Player: Influences the actions and opinions of others in a positive manner. Accepts feedback and incorporates it into actions. Builds group commitment.
Technical Skills: Ability to work in a matrix environment. Proficiency in Microsoft Office applications. Comprehensive knowledge of and ability to participate in and oversee:
• Case Management and Disease Management
• Clinical Quality and Continuous Quality Improvement
• Utilization Management, health care cost containment, and Managed Care practices
• URAC Standards and process and other accreditation standards as needed
• HIPAA regulations and requirements
Working Conditions
Working Conditions:
• Regular daytime hours with availability to work additional non-regular hours as needed
• Standard office environment, with limited to moderate travel
• Extensive computer work with prolonged sitting
• Security clearance may be required
Company Overview
Taking Care of Our Nation's Heroes.
It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!
Our job is to make sure that America's heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.