• 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 - South Carolina SE…

    Humana (Salem, OR)
    … 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 - Gulf South

    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 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 (07/08/25)
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  • Medical Director - Mid West Region

    Humana (Charleston, WV)
    … 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 (Bismarck, ND)
    … 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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  • Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    …vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where ... Utilization Management Admissions Liaison RN II...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
    LA Care Health Plan (07/12/25)
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  • Medical Director - Medicaid (IL)

    CVS Health (Springfield, IL)
    …a regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
    CVS Health (06/27/25)
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  • Utilization Review Care Management…

    Intermountain Health (Las Vegas, NV)
    **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... the Enterprise. The individual works in partnership with the Medical staff, Contracting, OPOE, Compliance, and Revenue Cycle leaders...and attainment of financial goals. Reporting to the Sr. Director /AVP/VP Utilization Management , the role… more
    Intermountain Health (07/02/25)
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