Utilization Management Director jobs in Oregon

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Remote Utilization Management RN
  • Clinical Management Consultants
  • McMinnville, OR FULL_TIME
  • A renowned coordinated care facility is actively seeking a Remote Utilization Management RN to join their team.

    The Following Qualifications Are Preferred

    • Medicaid regulatory experience (Oregon Medicaid preferred)
    • Health Plan Utilization Management: experience reviewing for medical necessity using clinical guidelines as a payer / insurance plan
    • Staff supervision and program management experience
    • RN license in the state of Oregon

    The Remote Utilization Management RN will play a vital role within this Coordinated Care Organization (CCO). The Utilization Management RN is responsible for overseeing the utilization management process and will lead a team of professionals in reviewing healthcare services, ensuring their medical necessity and appropriateness while complying with regulations and industry standards. This role involves following policies and procedures, monitoring compliance, and analyzing data to improve processes. The Utilization Management Nurse will also communicate with healthcare providers and insurance companies, advocate for patients' rights, and drive continuous improvement initiatives.

    Take this exciting opportunity to join a renowned facility as its Remote Utilization Management RN. This role offers a competitive salary and generous benefits. Apply today to learn more about this opportunity!

    Utilization Management, UM Manager, Healthcare Utilization, Clinical Review, Medical Necessity, Utilization Review, Healthcare Compliance, Policy Development, Quality Assurance, Regulatory Compliance, Data Analysis, Performance Metrics, Healthcare Resource Allocation, Denial Management, Appeals Process, Team Leadership, Healthcare Guidelines, Cost Containment, Continuous Improvement, Healthcare Quality, Patient Advocacy, Healthcare Budget Management, Healthcare Reimbursement, Healthcare Administration, Health Plan Compliance, Medical Decision Making, Healthcare Documentation, Clinical Guidelines, Managed Care, Medical Review Team, Healthcare Audits, Healthcare Policies, Healthcare Procedures, Healthcare Regulations, Case Management, Healthcare Data Management, Healthcare Operations, Healthcare Communication, Provider Relations, Healthcare Cost Control. utilization management, case management, health plan, medical group, oregon, oregon health plan, healthcare leadership, leadership, career, jobs , Oregon
  • 4 Days Ago

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Remote Utilization Management Manager
  • Clinical Management Consultants
  • Mcminnville, OR FULL_TIME
  • A renowned coordinated care facility is actively seeking a Remote Utilization Management Manager to join their team. The following qualifications are preferred: Medicaid regulatory experience (Oregon ...
  • 1 Month Ago

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Utilization Management Specialist RN
  • MultiCare Health System
  • Myrtle Point, OR FULL_TIME
  • You Belong Here. At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities fo...
  • 21 Days Ago

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Utilization Management Clinician - Behavioral Health
  • PacificSource
  • Springfield, OR FULL_TIME
  • Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants w...
  • 12 Days Ago

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Utilization Management Clinician - Behavioral Health
  • PacificSource
  • Bend, OR FULL_TIME
  • Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants w...
  • 12 Days Ago

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Social Work Professional ARRMC (Utilization Management)
  • Asante Health System
  • Medford, OR FULL_TIME
  • Social Work Professional ARRMC (Utilization Management) Additional Position Details: FTE: 0.000001 | On Call | Hours will primarily fall within Monday-Friday 0800-1700 Clinical supervision available f...
  • Just Posted

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Managing Director
  • Principal Financial Group
  • Miami, FL
  • Managing Director - Miami; Principal Financial Network 42364 Sales Regular Full-Time Miami, Florida No A048000-West Cent...
  • 6/11/2024 12:00:00 AM

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Managing Director, Conflict Management & Dispute Resolution
  • Dallas College
  • Dallas, TX
  • Position Summary The Managing Director of Conflict Management & Dispute Resolution will be responsible for effectively d...
  • 6/10/2024 12:00:00 AM

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Managing Director, Business Management
  • Applied Materials
  • Santa Clara, CA
  • Managing Director, Business Management page is loaded Managing Director, Business Management Apply locations Santa Clara...
  • 6/10/2024 12:00:00 AM

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Managing Director
  • Experis
  • Winston-Salem, NC
  • Build your career with Experis, a ManpowerGroup company as we connect human potential to the power of business. Through ...
  • 6/9/2024 12:00:00 AM

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Managing Director / Senior Managing Director - Debt Advisory
  • Oberon Securities, LLC
  • New York, NY
  • Oberon Securities, based in New York City, is seeking experienced Managing Directors with expertise raising asset, cash ...
  • 6/8/2024 12:00:00 AM

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Managing Director Investment Management
  • Leadenhall Search & Selection
  • Leadenhall Search & Selection are currently recruiting for Directors and Partners on behalf of a global, fast-growing In...
  • 6/8/2024 12:00:00 AM

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Senior Relationship Manager - Director - Managing Director
  • Deutsche Bank
  • Miami, FL
  • Job Description: Job Title Relationship Manager Corporate Title Director to Managing Director Location Miami, FL Overvie...
  • 6/7/2024 12:00:00 AM

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SVB - Managing Director- Relationship Management- Fund Banking
  • First Citizens Bank
  • Boston, MA
  • Overview: Together, Silicon Valley Bank and First Citizens offer you the strength and stability of a diversified financi...
  • 3/29/2024 12:00:00 AM

Oregon (/ˈɒrɪɡən/ (listen) ORR-ih-gən) is a state in the Pacific Northwest region on the West Coast of the United States. The Columbia River delineates much of Oregon's northern boundary with Washington, while the Snake River delineates much of its eastern boundary with Idaho. The parallel 42° north delineates the southern boundary with California and Nevada. Oregon is one of only four states of the continental United States to have a coastline on the Pacific Ocean. Oregon was inhabited by many indigenous tribes before Western traders, explorers, and settlers arrived. An autonomous government ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$129,167 to $174,661

Utilization Management Director in Abilene, TX
With an ever-increasing emphasis on reducing costs while still improving patient outcomes, utilization management is taking on new importance.
February 09, 2020
Utilization Management Director in Las Vegas, NV
Read more about the Humana Behavioral Health utilization management process and how it determines patient care.
February 18, 2020
Utilization Management Director in Boise, ID
Provides thought leadership on utilization initiatives and activities to enhance interdepartmental coordination.
December 19, 2019