• Medical Director - Nat'l UM IP (4x10…

    Humana (Santa Fe, NM)
    …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
    Humana (11/07/25)
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  • Medical Director - Nat'l UM Team Alt…

    Humana (Santa Fe, NM)
    …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... weekend with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more
    Humana (11/12/25)
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  • Director , Clinical Care Services - New…

    Magellan Health Services (Albuquerque, NM)
    …Prepares monthly performance reports with audit results. Presents findings at provider, customer, UM and CM meetings as needed. + Audits and reviews case manager, ... Health guide, UM staff, vendor, and provider documentation and telephone interactions...verbal and written communications skills. General Job Information Title Director , Clinical Care Services - New Mexico, Remote Grade… more
    Magellan Health Services (01/08/26)
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  • Managing Director , Product Management

    Evolent (Santa Fe, NM)
    …Be Doing:** **What You'll Be Doing:** Evolent is seeking an experienced Managing Director of Product Management to help Evolent grow by partnering with Payers to ... 'jobs to be done' and practice workflows, with a preference for expertise in UM workflows + Exceptional verbal and written communication skills, with the ability to… more
    Evolent (11/27/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Roswell, NM)
    …at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and under-utilization. * Educates ... and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of… more
    Molina Healthcare (01/07/26)
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  • Clinical Reviewer, Nurse (Medical Oncology)

    Evolent (Santa Fe, NM)
    …within the **RN/LVN/LPN** scope of practice, under the Medical Director 's direction, using independent nursing judgement and decision-making, physician-developed ... and refers cases that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers quality issues to UM Leadership. +… more
    Evolent (12/10/25)
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