• Director , Virtual Care Center

    UPMC (Pittsburgh, PA)
    …patient care through innovation? UPMC Nursing is seeking a dynamic Director , Virtual Care Center to launch enterprise-wide virtual nursing initiatives. In ... centralized cardiac monitoring unit and other aspects of virtual care programs. The Director is responsible for.... + Develops and implements new areas of clinical utilization for all Virtual Care programs. +… more
    UPMC (08/08/25)
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  • Regional Medical Director

    UPMC (Media, PA)
    …to Community Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy ... the provider network for the clinical needs of Community Care members. The Medical Director also participates...a regional perspective. + Supports member satisfaction with the care management process. + Implements quality … more
    UPMC (08/08/25)
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  • Director Care Management

    Highmark Health (Natrona Heights, PA)
    …:** **GENERAL OVERVIEW:** Provides operational and strategic leadership for Hospital/facility Care Management Department. Collaborates with nursing and clinical ... level of care determination practices. (20%) + Studies and implements the care management model and structure to achieve sustainable length of stay, resource… more
    Highmark Health (06/28/25)
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  • Remote Medical Director - Pennsylvania

    Centene Corporation (Harrisburg, PA)
    …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,...coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. +… more
    Centene Corporation (06/07/25)
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  • Field Medical Director , Interventional…

    Evolent (Harrisburg, PA)
    …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (07/30/25)
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  • Medical Director , MSK Surgery

    Evolent (Harrisburg, PA)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Director of Managed Care Contracting

    Select Medical (Mechanicsburg, PA)
    **Overview** The Director of Managed Care Contracting is responsible for leading the strategic planning, financial analysis, negotiation, and execution of new ... development of favorable contracts that exceed the cost of care delivery. Additionally, the Director will work...+ Serve as Hospital, payor relations, admissions, and case management support. + Promote use of Contract Information System… more
    Select Medical (08/11/25)
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  • Behavioral Health Medical Director

    Humana (Harrisburg, PA)
    …Health Medical Director will attend and participate in meetings involving care management , provider relations, quality of care , audit, grievance ... metrics, population health, and disease or care management . The Behavioral Health Medical Director may...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (08/09/25)
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  • Field Medical Director , Cardiology

    Evolent (Harrisburg, PA)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... you will be a key member of the utilization management team. We can offer you… more
    Evolent (08/15/25)
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  • Field Medical Director -Vascular Surgery

    Evolent (Harrisburg, PA)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... you will be a key member of the utilization management team. We can offer you… more
    Evolent (08/03/25)
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