• Director Quality Management/…

    Elevance Health (Boston, MA)
    ** Director Quality Management/ Improvement ** This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while ... an accommodation is granted as required by law._ The ** Director Quality Management/ Improvement ** is responsible for developing,...the contract related to Quality. + Leads Quality Measure Improvement Plan including HEDIS , Health Equity and… more
    Elevance Health (10/13/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …conjunction with the Director of PHM/ Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician Reviewers. ... programs and work plans. + Assists the Chief Medical Officer and the Quality Improvement Director in creating and maintaining a system that gives feedback to… more
    Sharp HealthCare (10/18/25)
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  • Medicaid Quality Management Health Plan…

    Elevance Health (Washington, DC)
    …management skills + Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet ... quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement , NCQA accreditation...onsite will be discussed as part of the hiring process . The health of our associates and communities is… more
    Elevance Health (10/22/25)
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  • REMOTE - Medical Director , Health Plan

    Martin's Point Health Care (Portland, ME)
    …leadership in, or focused activity of, a Health Plan (preferred) + Knowledge of process improvement tools + Experience in Health Plan utilization management + ... Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the...MLR , inpatient days/1000, SNF days/1000, and clinical quality improvement (QI) objectives, including HEDIS and how… more
    Martin's Point Health Care (09/22/25)
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  • Director of Quality and Risk Adjustment

    HCA Healthcare (Campbell, CA)
    …nature of Quality and Risk Adjustment programs + Recommend areas of process improvement and best-practice medical office/physician workflows utilizing EMR and ... HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a Director of Quality and Risk Adjustment with HCA Healthcare, you can be a… more
    HCA Healthcare (10/23/25)
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  • Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …and Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager. + Participates in the grievance process with the Chief ... in short and long range program planning, total quality management (quality improvement ), and external relationships. Works with all departments of Health Services… more
    Sharp HealthCare (08/17/25)
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  • Medical Director

    Molina Healthcare (Albuquerque, NM)
    … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (10/22/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Lincoln, NE)
    … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (10/18/25)
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  • Medical Director , Behavioral Health…

    MVP Health Care (Rochester, NY)
    …a healthier future for everyone - which requires innovative thinking and continuous improvement . To achieve this, we're looking for a **Medical Director , ... in a clinical setting). Previous experience as a medical director in a managed care/health plan is desirable. +...+ Knowledge of and experience with NCQA requirements and HEDIS reporting is desirable. + Strong organizational, communication, and… more
    MVP Health Care (09/24/25)
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  • Medical Director , Commercial Line…

    Excellus BlueCross BlueShield (Rochester, NY)
    …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... medical policies, guidelines and medical criteria. + Assists with training medical director colleagues and nursing staff , including leadership of teaching grand… more
    Excellus BlueCross BlueShield (09/30/25)
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