• National Utilization…

    Humana (Springfield, IL)
    **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
    Humana (06/06/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Springfield, IL)
    …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
    Zurich NA (05/22/25)
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  • Director Care Management

    AdventHealth (Bolingbrook, IL)
    … Management Facility Director reports directly to the Division Care Management Director with a matrix reporting relationship dotted line to the Facility ... Providers and keep the CMOs updated. The Facility Care Management Director communicates regularly with the CFO...to achieve goals . Works collaboratively with leaders of Utilization Management to quickly and efficiently address… more
    AdventHealth (05/29/25)
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  • Director of Care Management

    Humana (Springfield, IL)
    …to RN, LCSW, LCPC. + 8+ years of clinical experience, to include a combination of Utilization Management Case Management and Managed Care. + 5+ years of ... health first** Humana Gold Plus Integrated is seeking a Director of Care Management to lead a...of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or… more
    Humana (06/03/25)
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  • Medical Director - Medicaid N. Central

    Humana (Springfield, IL)
    …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (05/14/25)
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  • Medical Director - Illinois

    Centene Corporation (Springfield, IL)
    …unit. This position is REMOTE! + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
    Centene Corporation (03/29/25)
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  • Medical Director , MSK Surgery

    Evolent (Springfield, IL)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Medical Director - Care Plus - Florida

    Humana (Springfield, IL)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (04/24/25)
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  • Field Medical Director , Interventional…

    Evolent (Springfield, IL)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (04/30/25)
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  • Medical Director - Florida

    Humana (Springfield, IL)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (06/05/25)
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