• Medical Director , Medical…

    Highmark Health (Harrisburg, PA)
    …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
    Highmark Health (10/15/25)
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  • Medical Director - OneHome

    Humana (Harrisburg, PA)
    …reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
    Humana (09/27/25)
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  • Medical Director - Utilization…

    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 , ... role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and… more
    UPMC (10/03/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …training, education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external… more
    Wellpath (08/08/25)
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  • Field Medical Director , Pain…

    Evolent (Harrisburg, PA)
    …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...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

    Select Medical (Hummelstown, PA)
    …**Hospital Name: Penn State Health Rehabilitation Hospital** **Partnership with Select Medical ** **Position:** Director of Case Management **Schedule:** ... management criteria, and implementation of safe and appropriate discharge plans. The Director of Case management is also responsible for maintaining a patient… more
    Select Medical (08/29/25)
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  • Director of Quality Management

    Select Medical (Harrisburg, PA)
    …Calendar + Receiving and reviewing quarterly quality improvement reports. + Assisting the Medical Director and Quality Program Director with development and ... **Overview** **Critical Illness Recovery Hospital** ** Director of Quality Management ** At Select...** At Select Specialty/Regency Hospitals, a division of Select Medical , we care for chronically and critically ill or… more
    Select Medical (08/27/25)
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  • Medical Director - Gulf South

    Humana (Harrisburg, PA)
    … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
    Humana (10/03/25)
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  • Director , Medical Operations

    UPMC (West Mifflin, PA)
    …is housed. Works directly with, and under the direction of, the STAT MedEvac Medical Director and his/her Associate Medical Directors regarding all clinical ... moves or closings. + Participate/oversee special project development as designated by the Medical Director and/or the President/CEO. + Protect the privacy of all… more
    UPMC (10/14/25)
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  • Regional Medical Director

    UPMC (Media, PA)
    …Behavioral Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical ... for the clinical needs of Community Care members. The Medical Director also participates in regional leadership... aspects of cost and utilization reports generated by Medical Management Information System. + Acts as… more
    UPMC (08/08/25)
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