• Director , Utilization

    Alameda Health System (Oakland, CA)
    Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
    Alameda Health System (08/08/25)
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  • Director Utilization

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    About The Role The Director , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling… more
    Brighton Health Plan Solutions, LLC (07/18/25)
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  • Medical Director Utilization

    AmeriHealth Caritas (Philadelphia, PA)
    ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management , ... policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The… more
    AmeriHealth Caritas (08/12/25)
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  • Medical Director Utilization

    Henry Ford Health System (Clinton Township, MI)
    GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford Macomb… more
    Henry Ford Health System (08/13/25)
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  • Utilization Management Medical…

    Elevance Health (Winston Salem, NC)
    ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... North Carolina. Alternate locations may be considered. The **Medical Director ** will be responsible for utilization review...The **Medical Director ** will be responsible for utilization review case management for North Carolina… more
    Elevance Health (08/29/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …for training, education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
    Wellpath (08/08/25)
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  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …decrease peer to peer reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
    Monte Nido (09/06/25)
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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. This ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management more
    UPMC (07/11/25)
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  • Director of Case Management

    Prime Healthcare (Inglewood, CA)
    …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... ie full-time or part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case Management more
    Prime Healthcare (08/26/25)
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  • Medical Director - Southeast Region

    Humana (St. Paul, MN)
    Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (09/10/25)
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