• Senior Medical Director Appeals,…

    Centene Corporation (Jefferson City, MO)
    …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (01/06/26)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
    Excellus BlueCross BlueShield (12/29/25)
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  • RN Director , Utilization Management…

    Fallon Health (Worcester, MA)
    …of care opportunities related to Utilization Management. + Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical ... purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief ... necessities and criteria for coverage. + Oversight of UM by delegated organizations and ensure regulatory and accreditation… more
    Fallon Health (12/14/25)
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  • Senior Director , Operations & Ancillary…

    University of Michigan (Ann Arbor, MI)
    Senior Director , Operations & Ancillary Services **Extended Site Maintenance** We are performing updates and maintenance to our applicant experience. As a result, ... position. **Job Summary** Operations, Ancillary Services, and Safety Preparedness at UM Health is seeking a strategic, highly motivated, results-oriented leader to… more
    University of Michigan (01/16/26)
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  • 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 ... utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and… more
    Magellan Health Services (01/08/26)
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  • Director , Utilization Management

    Alameda Health System (Oakland, CA)
    Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
    Alameda Health System (11/07/25)
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  • Executive Director , Research…

    University of Miami (Coral Gables, FL)
    …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Executive Director of the Office of Research Administration ... and management of ORA's mission for the Coral Gables, Rosenstiel, and Medical Campuses for Pre-award, Post-award, and the Strategic Initiatives divisions. The… more
    University of Miami (12/20/25)
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  • Medical Director - Population Health

    CVS Health (Springfield, IL)
    …compassionate. And we do it all with heart, each and every day. + The Medical Director of Transitional Care leads the Illinois Transitional Nursing team and ... nursing, discharge planning, or home health. + Job DescriptionRole Description: The Medical Director , Transitional Care, APP is responsible for leading the… more
    CVS Health (01/16/26)
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  • Director of Development

    University of Miami (Miami, FL)
    …institutions of higher education in the US for its academic excellence, superior medical care, and cutting-edge research. At the U, we are committed to attracting ... to create an environment where everyone contributes to making UM a great place to work. We are one...Overview:The Philanthropy Officer is responsible for planning, developing, and managing the fundraising strategies and initiatives to support the… more
    University of Miami (12/20/25)
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  • Utilization Management RN

    Trinity Health (Des Moines, IA)
    …is also responsible for intervening with payers to prevent denial escalation, managing in-house expedited appeals, and conducting medical reviews for post-claim ... **Employment Type:** Full time **Shift:** **Description:** The UM Lead is responsible for overseeing day-to-day activities within the Utilization Management ( UM )… more
    Trinity Health (01/16/26)
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