• Medical Director

    UPMC (Pittsburgh, PA)
    The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to ... Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC… more
    UPMC (06/12/25)
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  • Regional Medical Director , Care…

    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....hospital VPMAs and presidents. The Regional Medical Director will have direct reports, including Physician more
    UPMC (07/11/25)
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  • LPN Utilization Mgmt Reviewer…

    Guthrie (Troy, PA)
    …the revenue cycle process, coordinates as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as Microsoft… more
    Guthrie (07/15/25)
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  • Medical Director , MSK Surgery

    Evolent (Harrisburg, PA)
    …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician more
    Evolent (05/20/25)
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  • Remote Medical Director

    Centene Corporation (Harrisburg, PA)
    …state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician committees including committee ... including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical more
    Centene Corporation (06/07/25)
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  • Medical Director , Grievances

    UPMC (Pittsburgh, PA)
    …The UPMC Health Plan is seeking a board-certified physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC ... weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and delivery… more
    UPMC (06/29/25)
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  • Medical Director - Florida

    Humana (Harrisburg, PA)
    …and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (07/29/25)
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  • Medical Director - South Carolina SE…

    Humana (Harrisburg, PA)
    …and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
    Humana (07/22/25)
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  • Field Medical Director , Cardiology

    Evolent (Harrisburg, PA)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (07/02/25)
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  • Field Medical Director -Vascular…

    Evolent (Harrisburg, PA)
    …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more
    Evolent (08/03/25)
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