• Medical Director - National…

    Humana (Austin, TX)
    **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 ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
    Humana (10/25/25)
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  • RN - UM / Medical Management Nurse…

    Elevance Health (Fort Worth, TX)
    …nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy ... care, eg, if services are not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems… more
    Elevance Health (10/22/25)
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  • Medical Director (AZ)

    Molina Healthcare (Fort Worth, TX)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/17/25)
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  • Medical Director -Medicaid (ABH TX)

    CVS Health (Austin, TX)
    …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This Medical Director will be a "Work from Home" position primarily supporting… more
    CVS Health (09/04/25)
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  • Medical Director (South Central…

    CVS Health (Austin, TX)
    …a Texas License without encumbrances or willing to obtain a Texas License. In the Medical Director role you will provide oversight for medical policy ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
    CVS Health (10/01/25)
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  • Medical Director

    Molina Healthcare (Houston, TX)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/22/25)
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  • Medical Director - Commercial

    CVS Health (Austin, TX)
    … UM experience with a Health plan/payor experience. *Electronic medical systems/record experience *Managed Care experience *Board certification in Internal ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management… more
    CVS Health (09/11/25)
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  • Chief Medical Officer, Ambetter

    Centene Corporation (Austin, TX)
    …one who changes everything for our 28 million members. **Position Purpose:** Chief Medical Director , Product provides strategic and clinical leadership to the ... related field preferred. 7+ years relevant experience required. Previous experience as Medical Director preferred. Board Certification through American Board of … more
    Centene Corporation (10/08/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Austin, TX)
    …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
    Evolent (10/21/25)
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  • Utilization Review Case Mgr-CMC-Clear Lake Center;…

    UTMB Health (Webster, TX)
    …or hospital transfers. If unsuccessful, elevates to department leadership and Senior Medical Director . Discharge Planning + Demonstrates skill in educating ... AS 400. + Demonstrates skill in accurately entering required UM data. + Monitors and facilitates appropriate utilization of...achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director .… more
    UTMB Health (10/22/25)
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