- Ami Network (Pasadena, CA)
- …AMI Network is partnered with a large healthplan organization to find their next Utilization Management Director in Pasadena. Our client is a leading ... Plans like Anthem, SCAN, and Alignment Health. As the Utilization Review Director , you'll oversee 4 direct...time. Requirements: Healthplan Experience + Medicare Advantage 3-5 years Management Experience RN in CA Daily audits of UM… more
- Healthcare Staffing (Zanesville, OH)
- Utilization Management & CDI Director page is loaded## Utilization Management & CDI Directorlocations: Genesis Hospitaltime type: Full timeposted on: ... Position Details:Work Shift:Day Shift (United States of America)Scheduled Weekly Hours:40Department: Utilization Management ## Overview of Position:The Director… more
- CVS Health Corporation (Oklahoma City, OK)
- A leading health solutions company is seeking a Utilization Management Medical Director to support the Aetna Oklahoma Medicaid plan. This remote role ... involves managing prior authorization, concurrent review and ensuring timely responses to members and providers. Ideal candidates will have significant experience in direct patient care, hold an active Oklahoma medical license and possess board certification… more
- Deltadentalin (Okemos, MI)
- … Utilization Management Plan are enforced on a day-to-day basis by the Utilization Management Director . The Utilization Management Director ... Director , Government Programs Dental Consulting and Utilization Management page is loaded## Director , Government Programs Dental Consulting and … more
- Healthcare Staffing (Zanesville, OH)
- A healthcare organization in Ohio is seeking a Utilization Management & CDI Director to oversee strategic management and clinical documentation ... initiatives. This role involves leadership of utilization review processes, collaboration across multidisciplinary teams, and adherence to regulatory standards. The… more
- CareMore Health System (California, MO)
- …Medical Director who will provide clinical leadership for utilization management . Responsibilities include overseeing review guidelines, collaborating with ... teams, and ensuring quality care. Candidates must hold a medical degree and have extensive clinical experience along with some background in managed care. The role involves mentoring and analyzing data to improve care standards. This position is ideal for… more
- Premera (Olympia, WA)
- …seeking an experienced **Oncologist** to join our team as an **Assistant Medical Director (AMD)**. The AMD will leverage their specialization in Oncology to provide ... member contracts. In addition, they will support clinical programs (disease and case management ), as well as the review and adoption of health plan developed review… more
- Humana Inc (Boston, MA)
- …of clinical experience, and strong communication skills. Responsibilities include conducting utilization management and participating in appeals. The position is ... A leading health insurance provider is seeking a Medical Director to interpret medical services and support healthcare professionals. The ideal candidate will… more
- Humana Inc (Honolulu, HI)
- … Director . The role involves providing medical interpretations, managing utilization of care, and collaborating with external healthcare providers. Applicants ... should hold an MD or DO degree with over 5 years of experience in clinical settings. The position is remote, requiring occasional travel, and offers competitive compensation along with comprehensive benefits, including health insurance and retirement plans.… more
- Humana Inc (Charleston, WV)
- A leading health services organization is seeking a Medical Director in Charleston, West Virginia. The role involves utilizing medical expertise to evaluate health ... services and ensure compliance with guidelines. The ideal candidate will have an MD or DO degree with a minimum of 5 years clinical experience, including inpatient care. Enjoy flexibility with remote work options while fulfilling regulatory compliance and… more
- UnitedHealth Group (Baltimore, MD)
- A healthcare organization is seeking a Medical Director to lead clinical reviews and support operations in Baltimore, Maryland. This role requires an MD or DO with ... board certification in Cardiology and over 5 years of clinical practice experience. Responsibilities include conducting coverage reviews, documenting clinical findings, and collaborating with healthcare providers. It offers an opportunity to work remotely… more
- Humana Inc (Annapolis, MD)
- A leading healthcare organization is looking for a Medical Director to oversee care quality and compliance, especially focusing on Medicare and Medicaid ... requirements. Ideal candidates should possess an MD or DO degree and have at least 5 years of clinical experience. Responsibilities include reviewing clinical scenarios, collaborating with healthcare teams, and ensuring compliance with regulations. The… more
- Humana Inc (Concord, NH)
- …The role includes medical interpretations, direct communication with healthcare providers, and utilization management . Ideal candidates should possess an MD or ... A leading healthcare company in Concord, NH, seeks a Medical Director to oversee health claims and ensure compliance with regulatory guidelines.… more
- Humana Inc (Bismarck, ND)
- A leading health services provider in North Dakota seeks a Medical Director to oversee clinical decisions and adherence to regulatory compliance. The role requires ... providing medical determinations, collaborating with healthcare professionals, and managing utilization for patient care. This position offers a competitive salary,… more
- Humana Inc (Phoenix, AZ)
- A healthcare insurance company is seeking a Medical Director to review health claims and provide medical interpretations within regulatory compliance. The ideal ... candidate will have 5+ years of clinical experience, an MD or DO degree, and strong analytical skills. This remote role includes occasional travel and offers a salary range of $223,800 - $313,100 per year, along with a bonus incentive plan. #J-18808-Ljbffr more
- Humana Inc (Honolulu, HI)
- A leading healthcare company is seeking a Medical Director to oversee clinical evaluations and decisions on healthcare services. The role requires an MD or DO ... degree, 5+ years of clinical experience, and solid communication skills. The position allows for remote work but may require occasional travel to offices. The compensation ranges from $223,800 to $313,100 annually, with eligibility for a bonus incentive plan.… more
- Humana Inc (Hartford, CT)
- A leading healthcare company is seeking a Medical Director to provide medical determinations and ensure compliance with clinical standards. The ideal candidate will ... possess an MD or DO degree, at least 5 years of clinical experience, and excellent communication skills. This remote position occasionally requires travel to company offices. Comprehensive benefits and a salary range of $223,800 - $313,100 per year are… more
- Humana Inc (Columbus, OH)
- A health insurance company in Ohio is seeking a Medical Director to oversee clinical determinations and ensure compliance with healthcare regulations. The role ... requires an MD or DO degree and at least 5 years of clinical experience. Ideal candidates will demonstrate strong communication skills and must hold current board certification. This position offers a competitive salary range of $223,800 - $313,100 with… more
- Humana Inc (Santa Fe, NM)
- …leading healthcare company in New Mexico is seeking a skilled Medical Director to oversee clinical determinations and compliance with national guidelines. The ideal ... candidate will have an MD or DO degree and over 5 years of clinical experience, with a focus on Medicare populations. Responsibilities include decision-making on healthcare services and collaborating with healthcare professionals to improve patient outcomes.… more
- Humana Inc (Pierre, SD)
- A national health organization is seeking a Medical Director to provide medical interpretations and determinations regarding healthcare services. This role requires ... extensive clinical experience and knowledge of Medicare requirements. The ideal candidate will work in a structured team environment, engaging in both clinical reviews and regional priority support. This position offers a competitive salary and comprehensive… more
