• Medical Director

    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 , ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
    UPMC (10/03/25)
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  • 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 (09/11/25)
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  • Medical Director Utilization

    AmeriHealth Caritas (Philadelphia, PA)
    **Role Overview:** The Medical Director , Utilization Management , provides organizational leadership in the operational areas of appeals, utilization ... and related policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical more
    AmeriHealth Caritas (09/23/25)
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  • Director Utilization Mgmt (Do Or MD…

    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 (08/08/25)
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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 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 (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 ... 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 (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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  • Field Medical Director , Pain…

    Evolent (Harrisburg, PA)
    …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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  • 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 (08/08/25)
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  • Field Medical Director

    Evolent (Harrisburg, PA)
    …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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