• Interim Director , Care

    Trinity Health (Des Moines, IA)
    …Type:** Full time **Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim ... West Des Moines. Operational responsibilities include budgeting, strategic planning, patient care management and integration and achieve organizational goals.… more
    Trinity Health (05/01/25)
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  • Utilization Management Care

    Intermountain Health (Las Vegas, NV)
    **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role...team in delivering and collaborating on all aspects of utilization management and care coordination… more
    Intermountain Health (04/18/25)
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  • Medical Director - Care Plus…

    Humana (Columbus, OH)
    …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (04/24/25)
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  • Medical Director - Medicaid N. Central

    Humana (Columbus, OH)
    …Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the KY, OH ... of decisions to internal associates, and possible participation in care management . The clinical scenarios arise from...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (04/24/25)
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  • Medical Director - Florida

    Humana (Columbus, OH)
    …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
    Humana (04/24/25)
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  • Assistant Director of Case…

    Mount Sinai Health System (New York, NY)
    …Case Management services, including utilization management , care facilitation and discharge planning. The Assistant Director works with the ... **Job Description** The Assistant Director of Case Management supports the... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
    Mount Sinai Health System (04/04/25)
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  • Market Director of Utilization

    Ascension Health (Nashville, TN)
    …efficiency, lead strategic initiatives in utilization management to optimize patient care and partner with the National Senior Director of UM to align on ... in the TN market. We're looking for an experienced Director of Utilization Management to...analysis to enhance our processes. You'll collaborate with Market Care Management , Finance, CDI, and Physician Advisors… more
    Ascension Health (04/25/25)
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  • Director of Case Management

    Prime Healthcare (Inglewood, CA)
    …Social Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure ... experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/ director -of-case- management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)… more
    Prime Healthcare (03/15/25)
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  • Medical Director , UM - Utilization

    Rady Children's Hospital San Diego (San Diego, CA)
    …team of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with the ... services are appropriately utilized while maintaining high standards of care and quality. The ideal candidate will have a...ideal candidate will have a strong pediatric clinical background. Utilization management experience is a plus. This… more
    Rady Children's Hospital San Diego (04/05/25)
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  • Medical Director Utilization

    AmeriHealth Caritas (Newtown Square, PA)
    …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership ... in the operational areas of care management , utilization review, appeals,...and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the… more
    AmeriHealth Caritas (04/11/25)
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  • Medical Director - Utilization

    UPMC (Pittsburgh, PA)
    The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
    UPMC (04/03/25)
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  • Group Utilization Review Director

    Tenet Healthcare (Detroit, MI)
    …Mgt. Leaders relating to Case Management scope of services, including utilization management , transition management promoting appropriate length of stay, ... Group Utilization Review Director - 2506000536 Description...and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials… more
    Tenet Healthcare (04/20/25)
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  • Director Utilization

    Intermountain Health (Murray, UT)
    …the full continuum of their healthcare journey. + Oversees program components related to care management and utilization review for the specific line of ... add programs to impact trends. + Uses a data-driven approach to assess utilization management and care management operations and make program… more
    Intermountain Health (04/04/25)
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  • Medical Director - Utilization

    AnMed Health (Anderson, SC)
    …direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at AnMed. The Medical Director ensures the program and ... The Utilization Review Medical Director supports operations...the leadership and staff who perform the functions of Utilization Management (UM), Case Management more
    AnMed Health (04/22/25)
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  • Utilization Review Medical Director

    Intermountain Health (Las Vegas, NV)
    …position interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network ... management , and finance. As the Medical Director for Utilization Management , you...at Intermountain Nevada who set the course for Clinical Care and Care Management Initiatives… more
    Intermountain Health (03/04/25)
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  • Corporate Director of Clinical…

    Prime Healthcare (Ontario, CA)
    …Responsibilities The Corporate Director of Clinical ... individual and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
    Prime Healthcare (04/17/25)
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  • Director Utilization Mgmt

    Wellpath (Lemoyne, PA)
    …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a… more
    Wellpath (03/25/25)
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  • Director of Utilization

    Insight Global (Boston, MA)
    Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the ... federal, state, and local regulatory guidelines. -Support the development of utilization management policy initiatives. -Support the development and… more
    Insight Global (04/26/25)
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  • Senior Director Utilization

    The Cigna Group (Bloomfield, CT)
    **Overall** Responsible for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate ... contracting efforts to ensure alignment across formulary, utilization management , SafeGuard, and other trend solutions....and inclusive team culture + Knowledge of PBM industry/Managed care / healthcare industry is desirable If you will be… more
    The Cigna Group (04/04/25)
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  • Manager, Care Coordination (RN)…

    Stanford Health Care (Palo Alto, CA)
    …leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships, ... Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs. + Assists Director ...+ Knowledge of principles and best practices of case management , utilization review, social work, care more
    Stanford Health Care (02/22/25)
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