- CenterWell (Boston, MA)
- … Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an ... understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director -...Medical Director ** will be responsible for utilization review case management for North Carolina ... opportunities. May serve as a resource to staff including Medical Director Associates. **How you will make...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- LifeCenter Northwest (Bellevue, WA)
- Director , Organ Utilization Job Details Job Location Bellevue HQ - Bellevue, WA Position Type Full Time Salary Range $140000.00 - $210000.00 Salary Job Posting ... Date(s) Start Date 11/19/2025 Description and Qualifications The Director , Organ Utilization ( Director ), is...Actively participates in Clinical Advisory Committee meetings. + Leads review and analysis of OPTN policy proposals and advises… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... Director , Utilization Management + Oakland, CA...reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance… more
- UNC Health Care (Morrisville, NC)
- …People** - Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate and empower ... well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational… more
- Wellpath (Lemoyne, PA)
- …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity ... trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and...with payers, as appropriate * May participate in the Utilization Review Committee to present medical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in...required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical … more