• Market Chief Medical Officer

    Catholic Health Initiatives (Chattanooga, TN)
    …and its hospitals. The MCMO has a partnership relationship with the Market Physician Enterprise President to lead key clinical service lines across the CHI Memorial ... market accountabilities as the MCMO include patient safety, patient experience, physician engagement, physician recruitment, and medical staff affairs. A… more
    Catholic Health Initiatives (11/21/25)
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  • Regional Medical Officer - SCMG - Sharp Corporate…

    Sharp HealthCare (San Diego, CA)
    …criteria development.Communicates with health plan clients and medical directors on utilization function. + Identifies physicians whose utilization and/or ... physicians regarding medical group policies and procedures and monitoring of physician compliance. Develops and implements physician sanction and grievance… more
    Sharp HealthCare (01/17/26)
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  • Chief Medical Officer

    WMCHealth (Valhalla, NY)
    …various clinical services in association with the DIO of NYMC + Reviews utilization of hospital clinical resources and provides guidance when corrective action is ... appropriateness of care including length of stay and resource utilization . + Establishes an environment of quality and cost... of resources and measure outcomes of care. Monitors physician data and presents analysis and interpretation of trends… more
    WMCHealth (11/04/25)
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  • Senior Director, Case Management

    Houston Methodist (Katy, TX)
    …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and strengthening… more
    Houston Methodist (01/16/26)
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  • Concurrent Denial Nurse BU

    Cleveland Clinic (Vero Beach, FL)
    …the world. As a Concurrent Denial Nurse, you will support the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient denials ... Registered Nurse who is a subject matter expert in utilization management, has experience with MCG criteria, and is...process issues. + Work in collaboration with the local physician advisor team and support the peer-to-peer process. +… more
    Cleveland Clinic (01/15/26)
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  • UM Denials Coordinator

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    About The Role BHPS provides Utilization Review services to its clients. The UM Denials Coordinator supports the Utilization Management function by reviewing ... and partially denied authorizations and preparing denial correspondence within the Utilization Management system. This role is responsible for drafting, editing, and… more
    Brighton Health Plan Solutions, LLC (01/02/26)
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  • Medical Management Educator

    Corewell Health (Grand Rapids, MI)
    …educational plan for the Behavioral Health, Care Management, and Utilization Management departments. Stakeholders include staff, physicians, department leadership, ... staff. Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with matrix reporting to other areas in Medical Management. +… more
    Corewell Health (12/19/25)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …direction, the Senior Medical Management Nurse is responsible for performing utilization review, case management, and quality improvement functions to ensure that ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and medical… more
    Ventura County (12/07/25)
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  • Acute Care Manager, Complex Care (RN)

    ChenMed (Columbus, OH)
    …patient/family conferences to review treatment goals and optimize resource utilization ; provides family education and identifies post-hospital needs. + Serves ... reports adverse occurrences, and performs staff education related to resource utilization , discharge planning and psychosocial aspects of healthcare delivery. +… more
    ChenMed (12/31/25)
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  • Field Medical Director, Pain Management

    Evolent (Madison, WI)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the ... utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. Aids and acts… more
    Evolent (12/25/25)
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