• Field Medical Director- (MD/DO)

    Evolent (Austin, TX)
    …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (09/26/25)
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  • Field Medical Director, Oncology

    Evolent (Austin, TX)
    …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (08/19/25)
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  • Medical Director, Behavioral Health (NE)

    Molina Healthcare (Houston, TX)
    …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 (10/03/25)
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  • Assistant Vice President/Associate Chief Medical…

    Texas Health Resources (Plano, TX)
    …also providing quality medical care. 5. Support effective patient throughput, utilization management , and compliant documentation. MEDICAL STAFF GOVERNANCE: 1. ... Credentials Committee to coordinate medical staff credentialing including the review of credentials, delineation of clinical privileges, development of privileges,… more
    Texas Health Resources (10/16/25)
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  • Physician Advisor

    Ascension Health (Austin, TX)
    …setting (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to ... of physicians apply today! **Responsibilities:** Work in areas of utilization management and denial mitigation, including but...and denial mitigation, including but not limited to: + Review medical records of identified patients to assist with… more
    Ascension Health (10/08/25)
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  • Care Review Clinician - Resident of NM…

    Molina Healthcare (TX)
    **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
    Molina Healthcare (09/27/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (TX)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
    Molina Healthcare (08/08/25)
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  • Medical Director - Florida

    Humana (Austin, TX)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (10/03/25)
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  • Medical Director - Mid West Region

    Humana (Austin, TX)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning and/or… more
    Humana (09/16/25)
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  • Medical Director - Northeast Region

    Humana (Austin, TX)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… more
    Humana (07/25/25)
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