Top 19 Utilization management Jobs in Great Bend, Ks

Medical Director
Blue Cross and Blue Shield of Kansas —Kansas
- Hybrid work
- Medicine
- 5 years
- US work authorization
- Paid parental leave
- Dental insurance
1d
Assistant Director of Nursing - Hospital - GB
The University of Kansas Health System —Great Bend, KS
- Full-time
- Nursing
- RN License
- Hospital
1d
Registered Nurse
HaysMed —Larned, KS
- $26 - $38 an hour
- Full-time
- Nursing
- RN License
- Hospital
Physician ED Claims Reviewer
Vytwo —United States
- Full-time
- Remote
- Mid-level
- 2 years
Quick Apply
Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply

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Assistant Director of Nursing - Hospital - GB
The University of Kansas Health System —Great Bend, KS
Master Degree Nursing in Nursing, Hospital Administration, Business Administration or related field within 5 years. Great Bend Medical Office Building.
1d

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Outpatient Intake Assessment Specialist
Highlife Recovery —Columbus, OH
Complete comprehensive biopsychosocial assessments and diagnostic evaluations within the clinician’s license and scope of practice.
$60,000 - $70,000 a year
Quick Apply
2d
Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply

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utilization management jobs near great bend, ks

Medical Director

Blue Cross and Blue Shield of Kansas -
Kansas

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Job Details

1 day ago

Benefits

Paid parental leave
Caregiver leave
Dental insurance
Tuition reimbursement
Adoption assistance
Parental leave
Vision insurance
401(k) matching
Gym membership

Qualifications

Team leadership
Medical License

Full Job Description

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
Professional Growth Opportunities: Advance your career with ongoing training and development programs.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP)
Health/Vision/Dental insurance
6 weeks paid parental leave for new mothers and fathers
Fertility/Adoption assistance
2 weeks paid caregiver leave
401(k) plan matching up to 5%
Tuition reimbursement
Health & fitness benefits, discounts and resources

Job Summary

The Medical Director will serve as a clinical subject matter expert responsible for supporting the plan utilization management, medical review and population health management programs across all lines of BCBS Kansas lines of business. As a clinical subject matter expert, the Medical Director, may also as needed provide support to plan programs including but not limited to medical policy development, quality management, and provider network management. This position requires a strong clinical background, leadership skills, and the ability to promote collaboration across functional areas to achieve organizational goals and objectives.

"This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

Support utilization management and medical review activities including prior authorization, concurrent review, appeals processes, and claim review to ensure the appropriate use of healthcare services and resources. Provide clinical subject matter expertise to support medical necessity determinations and utilization review criteria.
Support the development and maintenance of medical policies, clinical guidelines, and coverage determinations based on evidence-based medicine. Ensure alignment with organizational goals, industry standards, and best practices.
Foster collaboration and communication among cross-functional teams, including medical directors, pharmacy, behavioral health, care management, and operations professionals to develop integrated care management strategies and improve care coordination.
Provide clinical subject matter expertise across all BCBSKS lines of business.
Provide clinical subject matter expertise as needed to support clinical programs and initiatives aimed at improving health outcomes, reducing costs, patient safety and enhancing member satisfaction. Analyze clinical data, identify opportunities for quality improvement, develop strategies to address gaps in care, reduce variation, and promote best practices.
Ensure compliance with state and federal regulations, accreditation standards, and health plan requirements related to utilization management, medical review, and medical policy. Stay abreast of changes in healthcare policy and reimbursement and implement necessary measures to maintain compliance.

Knowledge/Skills/Abilities

Commitment to evidence-based medicine, quality improvement, and healthcare innovation.
Effective oral and written communicator.

Education and Experience

Medical degree (MD or DO) from an accredited institution required.
Completion of residency training program in ABMS/AOA recognized clinical specialty required.
ABMS/AOA board certification in a relevant medical specialty required, adult primary care specialty preferred.
Current, active, and unrestricted medical license in a state to practice medicine in the state of Kansas required.
5+years of clinical experience required, Experience with managed care/health insurance preferred.
Experience with Medicare Advantage (MA) and/or Affordable Care Act (ACA) populations, including demonstrated involvement in Utilization Management (UM) reviews preferred.

Physical Requirements

Able to work in a company office in Kansas or remote work

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Refine Your Search

utilization management jobs in great bend, ks

Medical Director

Assistant Director of Nursing - Hospital - GB

Registered Nurse

Physician ED Claims Reviewer

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)

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