• Utilization Management Dental…

    Humana (Austin, TX)
    …a part of our caring community and help us put health first** The Dental Director is responsible for providing clinical oversight to promote the oral health of the ... of claims, appeals, and potential quality of care issues. The Dental Director - Texas assists in the design, development, and implementation of appropriate… more
    Humana (08/23/25)
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  • Utilization Review Case Mgr - CMC…

    UTMB Health (Webster, TX)
    Utilization Review Case Mgr - CMC - Clear...target. + Presents LOS variances for review to Director and Inpatient Medical Director . Transfer ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
    UTMB Health (08/21/25)
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  • Remote Medical Director - Texas

    Centene Corporation (Austin, TX)
    … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
    Centene Corporation (08/16/25)
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  • Field Medical Director

    Evolent (Austin, TX)
    …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization more
    Evolent (07/30/25)
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  • National Accounts Medical Director

    Elevance Health (Houston, TX)
    …: + Day to day clinical responsibilities means that the medical director provides clinical oversight for Utilization Management, Case Management, and Total ... **National Accounts Medical Director ** Location: This role enables...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (08/27/25)
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  • Medical Director - National Medicare

    Humana (Austin, TX)
    …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... Medicaid. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
    Humana (08/21/25)
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  • Director , Physician Leadership…

    Humana (Austin, TX)
    …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... performing utilization management for inpatient authorizations training medical director team to assist and facilitate...**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure… more
    Humana (08/21/25)
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  • Field Medical Director , Cardiology

    Evolent (Austin, TX)
    …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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/15/25)
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  • Field Medical Director - Vascular…

    Evolent (Austin, TX)
    …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... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (08/28/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Austin, TX)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
    Molina Healthcare (08/28/25)
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