• Utilization Management

    Elevance Health (Columbus, OH)
    ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
    Elevance Health (09/26/25)
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  • Field Medical Director

    Evolent (Columbus, OH)
    …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management more
    Evolent (07/30/25)
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  • Medical Director - Gulf South

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical more
    Humana (10/03/25)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
    Humana (09/16/25)
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  • Medical Director - Northeast Region

    Humana (Columbus, OH)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical more
    Humana (07/25/25)
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  • National Accounts Medical Director

    Elevance Health (Columbus, OH)
    …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
    Elevance Health (09/23/25)
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  • Field Medical Director , Pain…

    Evolent (Columbus, OH)
    …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
    Evolent (09/25/25)
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  • Medical Director (AZ)

    Molina Healthcare (Columbus, OH)
    …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
    Molina Healthcare (09/26/25)
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  • Field Medical Director , Cardiology

    Evolent (Columbus, OH)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
    Evolent (10/01/25)
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  • Field Medical Director - Vascular…

    Evolent (Columbus, OH)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
    Evolent (08/28/25)
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  • Medical Director -Payment Integrity

    Humana (Columbus, OH)
    …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (09/26/25)
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  • Medical Director , Behavioral Health…

    Molina Healthcare (Columbus, OH)
    …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management...**REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3… more
    Molina Healthcare (09/13/25)
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  • Manager, Medical Director

    Elevance Health (Columbus, OH)
    …or healthcare leadership preferred. + Experience advising medical cost management , utilization management , payment integrity, or provider performance ... **Manager, Medical Director - Transformation Initiatives** Location:...+ **Cost of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM)… more
    Elevance Health (10/04/25)
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  • Field Medical Director , Oncology

    Evolent (Columbus, OH)
    …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
    Evolent (08/19/25)
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  • Field Medical Director , (Orthopedic…

    Evolent (Columbus, OH)
    …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be...Surgery you will be a key member of the utilization management team. We can offer you… more
    Evolent (08/29/25)
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  • Medical Director , Behavioral Health…

    Molina Healthcare (Columbus, OH)
    …closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and ... and clinical leadership for health plan and/or market specific utilization management and care management ...health portions of state contracts. * Assists behavioral health medical director lead trainers in the development… more
    Molina Healthcare (10/03/25)
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  • Medical Director - Long Term Support…

    Elevance Health (Columbus, OH)
    ** Medical Director -Long Term Support and Services** _Preferred Location: Ohio._ _Please note that per our policy t_ _his role enables associates to work ... health, behavioral health, long term services and supports, and psychosocial needs._ The ** Medical Director -Long Term Support and Services** is responsible for… more
    Elevance Health (09/26/25)
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  • Medical Director - Commercial

    Elevance Health (Columbus, OH)
    …time zone hours.** The ** Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... ** Medical Director - Commercial** Location: This role...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
    Elevance Health (10/04/25)
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  • Medical Director - Medical

    Elevance Health (Columbus, OH)
    ** Medical Director - Medical Policy** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... required by law. Alternate locations may be considered. The ** Medical Director - Medical Policy** is...+ Supports coordination with external entities that develop clinical utilization management guidelines used by Company Plans… more
    Elevance Health (10/04/25)
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  • US Strategy Lead Director Medical

    Merck (Columbus, OH)
    **Job Description** **Role Summary** The US Director Medical Affairs (USDMA) is a regionally based position within our Company Research Laboratories, US ... science. + Manage programs (ie patient support, education, risk management ) as needed for appropriate and safe utilization...including Health Systems. + Collaborate with the USMA Field Medical Alignment Director (FMAD) to ensure consistent… more
    Merck (09/13/25)
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