• 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 UPMC ... care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working… more
    UPMC (06/12/25)
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  • Medical Director Utilization…

    AmeriHealth Caritas (Philadelphia, PA)
    ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management, ... related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs.… more
    AmeriHealth Caritas (08/12/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
    Wellpath (08/08/25)
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  • Regional Medical Director , Care Management…

    UPMC (Pittsburgh, PA)
    The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... focuses on improving patient flow, resource utilization , and length of stay (LOS) strategic oversight. The...and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care… more
    UPMC (07/11/25)
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  • Medical Director - National Medicare

    Humana (Harrisburg, PA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... 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 … more
    Humana (08/21/25)
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  • Medical Director - NorthEast Region

    Humana (Harrisburg, PA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... 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 … more
    Humana (07/25/25)
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  • LPN Utilization Mgmt Reviewer - Medical…

    Guthrie (Troy, PA)
    Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
    Guthrie (07/15/25)
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  • Regional Medical Director

    UPMC (Media, PA)
    …(CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical Director is responsible ... Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network… more
    UPMC (08/08/25)
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  • Field Medical Director , Interventional…

    Evolent (Harrisburg, PA)
    …a meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... training 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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  • Director , Physician Leadership - Medical…

    Humana (Harrisburg, PA)
    …The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team ... are seeking an accomplished healthcare physician leader for the newly-created role of Director , Physician Leadership. In this role, you will be a key enterprise… more
    Humana (08/21/25)
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