The Utilization Management (UM) team is made up of experienced physicians and clinicians who work together to ensure Clover members receive medically appropriate, evidence-based care while optimizing quality and resource utilization. As the Medical Director, Utilization Management, you will
OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of
About Altais: At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks.
At Clover Health, we provide high-quality, affordable, and easy-to-understand healthcare for Americas seniors. Through the Clover Assistant, we combine data, technology, and preventive care to give physicians a more complete view of each members health—helping improve
About IntusCare IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual
Become a part of our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires
About IntusCare: IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united
Become a part of our caring community The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
Vice President of Bill Review Operations About the Company Innovative healthcare solutions provider specializing in insurance services Industry Insurance Type Privately Held Founded 2004 Employees 501-1000 Categories Insurance Specialties bill review out-of-network repricing primary ppo and alternative repricing
Job Description Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated
Utilization Management Coordinator II MSO Burlingame, CA 94010 Overview Salary Range $39.69 - $45.10 Hourly Description The Utilization Management Coordinator II functions under the direct supervision of a physician or Registered Nurse performing utilization management and care coordination duties
About Us Flourish and Thrive Labs is a woman-owned and led consulting firm specializing in public health solutions. Our team, composed of former public health officials, works with state and local health departments across the country,
About Us Flourish and Thrive Labs is a woman-owned and led consulting firm specializing in public health solutions. Our team, composed of former public health officials, works with state and local health departments across the country,
About Us Flourish and Thrive Labs is a woman-owned and led consulting firm specializing in public health solutions. Our team, composed of former public health officials, works with state and local health departments across the country,
Description KWH Constructors, Inc is a privately owned, growing steel erector with a construction engineering subsidiary. We are looking for a Project Manager to join our team in the San Francisco Bay area. KWH is committed
Job Summary As a patient-focused organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and
Under the supervision of the Administrative Director of the Department of Neurological Surgery-Spine, the Ambulatory Administrative Coordinator will work independently and have primary responsibility for the day-to-day oversight of administrative support services provided to faculty and
Why Harvey At Harvey, we’re transforming how legal and professional services operate. By combining frontier agentic AI, an enterprise-grade platform, and deep domain expertise, we’re reshaping how critical knowledge work gets done for decades to come.
Why Harvey At Harvey, we’re transforming how legal and professional services operate. By combining frontier agentic AI, an enterprise-grade platform, and deep domain expertise, we’re reshaping how critical knowledge work gets done for decades to come.