• 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 (11/07/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director , Utilization

    UPMC (Pittsburgh, PA)
    …UMPC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
    UPMC (12/11/25)
    - Save Job - Related Jobs - Block Source
  • Executive System Director

    UNC Health Care (Morrisville, NC)
    …and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system, including a… more
    UNC Health Care (10/29/25)
    - Save Job - Related Jobs - Block Source
  • Director Utilization

    Healthfirst (NY)
    …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… more
    Healthfirst (12/04/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Medical…

    Elevance Health (Indianapolis, IN)
    ** Utilization Management Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of ... Internal Medicine, and Family Medicine specialties preferred. + 3-5 years of Utilization Management experience preferred. + Indiana license or the ability… more
    Elevance Health (12/05/25)
    - Save Job - Related Jobs - Block Source
  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …education, and point of care support. **How you make a difference** 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 (11/07/25)
    - Save Job - Related Jobs - Block Source
  • Nurse Manager - Utilization Review

    Huron Consulting Group (Chicago, IL)
    …regulatory agencies, and hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with hospital ... review staff and function for the system, reporting to the Director of Utilization Management within Revenue Cycle. Assists with leading recruiting,… more
    Huron Consulting Group (11/27/25)
    - Save Job - Related Jobs - Block Source
  • 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 (10/18/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director - IP Claims…

    Humana (Raleigh, NC)
    …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (12/11/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Medicaid N. Central

    Humana (Indianapolis, IN)
    …to the Lead Medical Director - North Central Medicaid Markets. 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 (10/25/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Medicaid (remote)

    Humana (Baton Rouge, LA)
    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 (12/07/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Medical Affairs…

    CVS Health (Springfield, IL)
    …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
    CVS Health (10/23/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director Managed Care Physician…

    Dignity Health (Bakersfield, CA)
    …, remote patient monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
    Dignity Health (10/17/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director , Ventura County Health…

    Ventura County (Ventura, CA)
    …and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
    Ventura County (10/31/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
    LA Care Health Plan (10/03/25)
    - Save Job - Related Jobs - Block Source
  • VP Medical Management -Managed Care

    Dignity Health (Bakersfield, CA)
    …the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management (UM) and the Medical Director ... and experience leading complex and innovative delivery models. + Experience in Utilization Management activities. + Strong communication skills, and ability to… more
    Dignity Health (10/19/25)
    - Save Job - Related Jobs - Block Source
  • PCO Medical Director - UM - Full Time

    CenterWell (Boston, MA)
    …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical … more
    CenterWell (11/06/25)
    - Save Job - Related Jobs - Block Source
  • Supervisor Home Modification Specialist

    AmeriHealth Caritas (Philadelphia, PA)
    …us at www.amerihealthcaritas.com . **Responsibilities:** Under the supervision of the LTSS Manager/ Director for Utilization Management , this position is ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more
    AmeriHealth Caritas (11/13/25)
    - Save Job - Related Jobs - Block Source
  • Supv Regional Care Mgmt- Integrated Care Mgmt…

    Sharp HealthCare (San Diego, CA)
    …the direction of the manager of in-patient care management and the Director of Utilization Management . **Required Qualifications** + 3 Years Experience ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
    Sharp HealthCare (10/07/25)
    - Save Job - Related Jobs - Block Source
  • Senior Utilization Review Medical…

    Integra Partners (Troy, MI)
    … (Senior MD) serves as the clinical and strategic leader for Integra's Utilization Management (UM) and Credentialing programs. This is a full-time, 40+ ... quality and inter-rater reliability, overseeing audit readiness, and chairing Integra's Utilization Management Committee and Credentialing Committee. This role… more
    Integra Partners (12/03/25)
    - Save Job - Related Jobs - Block Source