• BroadPath Healthcare Solutions (Tucson, AZ)
    …staff on managed care and Medicaid policies and procedures D. Conducts staff and medical director audits on appeal activities + Assists with appeal file ... **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical … more
    DirectEmployers Association (09/24/25)
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  • BroadPath Healthcare Solutions (Tucson, AZ)
    …and present authorization requests with supporting documentation for review with the Medical Director . + Assume responsibility for ensuring timely reviews of ... Working knowledge of medical standards of practice or experience with using UM medical criteria (ie Milliman and InterQual) required. + Strong Computer… more
    DirectEmployers Association (09/13/25)
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  • Medical Director - National…

    Humana (Phoenix, AZ)
    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
    Humana (10/25/25)
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  • Medical Director (AZ)

    Molina Healthcare (Phoenix, AZ)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/17/25)
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  • Medical Director

    Molina Healthcare (Tucson, AZ)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/22/25)
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  • System VP Utilization Management

    CommonSpirit Health (Phoenix, AZ)
    …regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental ... + Leadership & Strategy: Lead the System-level Utilization Management ( UM ) department, ensuring alignment with organizational goals and regulatory standards.… more
    CommonSpirit Health (09/05/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Phoenix, AZ)
    …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
    Evolent (10/21/25)
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