• Medical Director - Nat'l UM…

    Humana (Santa Fe, NM)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
    Humana (11/07/25)
    - Related Jobs

  • Medical Director - Nat'l IP…

    Humana (Santa Fe, NM)
    …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
    Humana (11/15/25)
    - Related Jobs

  • Director , Clinical Care Services - New…

    Magellan Health Services (Albuquerque, NM)
    …to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health ... initiatives with providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding … more
    Magellan Health Services (01/08/26)
    - Related Jobs

  • Medical Director (Medicare)

    Molina Healthcare (Roswell, NM)
    …the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
    Molina Healthcare (01/07/26)
    - Related Jobs

  • Clinical Reviewer, Nurse ( Medical…

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