• 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. ... hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management ...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
    UPMC (07/11/25)
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  • Utilization Review Medical…

    Commonwealth Care Alliance (Boston, MA)
    …**Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... Serve as the lead for CCA's Utilization Review functions working closely with other medical management...+ Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed… more
    Commonwealth Care Alliance (06/27/25)
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  • RN- Utilization Review

    Ascension Health (Milwaukee, WI)
    **Details** + **Department:** Utilization Management + **Schedule:** Full Time, Partially Remote + **Hospital:** Multiple Ascension Hospitals in WI + ... **Responsibilities** Provide strategic direction and oversight of the day-to-day operation of utilization management function within the insurance plan. + Ensure… more
    Ascension Health (08/08/25)
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  • Utilization Review Care…

    Intermountain Health (Las Vegas, NV)
    **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... Utilization Management and Review for...Utilization Management and Review for the Enterprise. The...and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role… more
    Intermountain Health (07/02/25)
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  • Utilization Management Medical…

    Elevance Health (Durham, NC)
    …locations may be considered. The **Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid. May be ... ** Utilization Management Medical Director -...** Utilization Management Medical Director - NC Medicaid** Location:...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (08/08/25)
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  • Program Mgr UR/Case Management - CMC…

    UTMB Health (Friendswood, TX)
    …resource utilization to Director and/or Assistant Director of Utilization Review /Case Management . + Maintains a documentation system of all ... ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical… more
    UTMB Health (08/01/25)
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  • Director Utilization Mgmt (Do…

    Wellpath (Lemoyne, PA)
    …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
    Wellpath (08/08/25)
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  • Med Mgmt Clinician Sr (US)

    Elevance Health (Las Vegas, NV)
    …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
    Elevance Health (07/23/25)
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  • Supv Regional Care Mgmt - Integrated Care…

    Sharp HealthCare (San Diego, CA)
    …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
    Sharp HealthCare (07/09/25)
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  • Med Mgmt Nurse (US)

    Elevance Health (Denver, CO)
    …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of ... accommodation is granted as required by law._** The **Medical Management Nurse** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
    Elevance Health (08/08/25)
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