• Field Medical Director - Vascular Surgery

    Evolent (Columbus, OH)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (10/10/25)
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  • Field Medical Director , Cardiology

    Evolent (Columbus, OH)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (10/01/25)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned… more
    Humana (09/16/25)
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  • Medical Director -Long Term Support…

    Elevance Health (Lima, OH)
    …clinical consultation and serve as clinical/strategic advisor to clinical operations including utilization management , care management and quality ... state or territory of the United States when conducting utilization review or an appeals consideration and...services for target populations strongly preferred. + 1-2 years Utilization Management experience strongly preferred. + Strong… more
    Elevance Health (10/28/25)
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  • Medical Director , Behavioral Health…

    Molina Healthcare (Cleveland, OH)
    …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management ...all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the… more
    Molina Healthcare (10/17/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Columbus, OH)
    …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
    Molina Healthcare (10/29/25)
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  • Medical Director , Medical…

    Highmark Health (Columbus, OH)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
    Highmark Health (10/28/25)
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  • Field Medical Director , Oncology

    Evolent (Columbus, OH)
    …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/19/25)
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  • Director of Quality Management…

    Select Medical (Cleveland, OH)
    **Overview** **Cleveland Clinic Rehabilitation Hospital - Fairhill** ** Director of Quality Management ** **(DQM)** **Opening in October, the Cleveland Clinic ... documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control… more
    Select Medical (10/22/25)
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  • Medical Director , Behavioral Health (NE)

    Molina Healthcare (OH)
    …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs… more
    Molina Healthcare (10/23/25)
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