• Utilization Management…

    Elevance Health (Columbus, OH)
    ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of ... Alternate locations may be considered. The ** Medical Director ** will be responsible for utilization review case management for North Carolina Medicaid.… more
    Elevance Health (09/26/25)
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  • Field Medical Director…

    Evolent (Columbus, OH)
    …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
    Evolent (07/30/25)
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  • Medical Director - Gulf South

    Humana (Columbus, OH)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (10/03/25)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
    Humana (09/16/25)
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  • Medical Director - Northeast Region

    Humana (Columbus, OH)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (07/25/25)
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  • National Accounts Medical Director

    Elevance Health (Cincinnati, OH)
    …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
    Elevance Health (09/23/25)
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  • Field Medical Director , Pain…

    Evolent (Columbus, OH)
    …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
    Evolent (09/25/25)
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  • Director of Case Management ( RN…

    Select Medical (Middleburg Heights, OH)
    …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **_Clinical license...in social work and minimum three (3) years of medical case management or similar experience._** **Previous… more
    Select Medical (09/19/25)
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  • Medical Director (AZ)

    Molina Healthcare (Cleveland, OH)
    …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
    Molina Healthcare (09/26/25)
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  • Assistant Medical Director

    Medical Mutual of Ohio (OH)
    …and managed care principles. + Knowledge of health plan claims adjudication and utilization review processes preferred. Medical Mutual is looking to grow our ... Founded in 1934, Medical Mutual is the oldest and one of...clinical excellence; quality ratings improvement, appropriate inpatient and outpatient utilization , affordability, compliance, growth and focused improvement, and that… more
    Medical Mutual of Ohio (10/02/25)
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