- 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 , ... UPMC Health Plan members. They will oversee adherence to quality and utilization standards through committee delegations and further establish an effective working… more
- Integra Partners (Troy, MI)
- …as operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director (s), ensures consistent application of ... representing Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director 's responsibilities include but… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but… more
- Centene Corporation (Richmond, VA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Director of Health Services - Utilization Management Location: Hybrid | ... join us. The Impact You Will Have The Senior Director of Health Services, Utilization Management is...UM/Cost Protection * Accountabilities include the overall value of utilization management (UM) product, medical and reimbursement… more
- Martin's Point Health Care (Portland, ME)
- …prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse is responsible for ensuring the receipt...for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for… more
- Centene Corporation (Olympia, WA)
- …quality accreditation standards. + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Centene Corporation (Phoenix, AZ)
- …fresh perspective on workplace flexibility. **Position Purpose:** Assist the Sr Behavioral Health Medical Director to direct and coordinate the medical ... and credentialing functions for the business unit. + Provides medical leadership of all for utilization management,...initiatives for capitated providers. + Assists Sr Behavioral Health Medical Director in planning and establishing goals… more
- Centene Corporation (Indianapolis, IN)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Evolent (Phoenix, AZ)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more