• Medical Director…

    UPMC (Pittsburgh, PA)
    The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
    UPMC (06/12/25)
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  • Director Utilization Mgmt

    Wellpath (Lemoyne, PA)
    …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
    Wellpath (06/23/25)
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  • Regional Medical Director , Care…

    UPMC (Pittsburgh, PA)
    The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management … more
    UPMC (07/11/25)
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  • Medical Director - Florida

    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 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 (07/29/25)
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  • Medical Director - South Carolina SE…

    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 in an ... value based care, population health, or disease or care management . **Responsibilities** The Medical Director ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (07/22/25)
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  • Medical Director - Mid West Region

    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 in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
    Humana (05/14/25)
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  • Medical Director - NorthEast Region

    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 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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  • LPN Utilization Mgmt Reviewer…

    Guthrie (Troy, PA)
    …CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as ... to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with...with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as… more
    Guthrie (07/15/25)
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  • Regional Medical Director

    UPMC (Media, PA)
    …committees of the PH MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. + Acts as a ... a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The...Community Care members. This includes significant responsibility for quality management and utilization management and… more
    UPMC (07/03/25)
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  • Remote Medical Director…

    Centene Corporation (Harrisburg, PA)
    …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... Provides medical leadership of all for utilization management , cost containment, and medical...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
    Centene Corporation (06/07/25)
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