- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- 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
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry… more
- Elevance Health (Durham, NC)
- ** 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
- Wellpath (Lemoyne, PA)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
- Humana (Indianapolis, IN)
- … Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the ... 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 (Little Rock, AR)
- … 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
- CVS Health (Springfield, IL)
- …Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Humana (Lansing, MI)
- … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Tallahassee, FL)
- … 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 actively uses their medical...Integrated Delivery Systems, health insurance, other healthcare providers. + Utilization management experience in a medical… more
- Dignity Health (Bakersfield, CA)
- …remote patient monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing… more
- Elevance Health (Overland Park, KS)
- …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
- Dignity Health (Bakersfield, CA)
- …the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management (UM) and the Medical ... Relations, Customer Service, and Clinical Oversight functions. + Oversee and manage the medical director capacity to support Managed Care Services and approve… more
- LA Care Health Plan (Los Angeles, CA)
- …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- CVS Health (Springfield, IL)
- …a regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- CenterWell (Boston, MA)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health… more
- CVS Health (Des Moines, IA)
- …urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a medical director to be part of a...state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another… more
- UNC Health Care (Morrisville, NC)
- …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... Executive Director works closely with leaders from various departments-case management , physician advisors, revenue cycle, medical staff, nursing, and… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more