Medical Director, Utilization & Care Management

Highmark Health

Highmark Health in Nashville is seeking a physician to lead utilization management within a multidisciplinary team. You will review escalated cases, ensure medical necessity, and participate in policy development to align with current clinical standards. The role requires an MD or DO with active licensure and board certification, plus several years of direct patient care experience. Travel and collaboration across sites are expected. #J-18808-Ljbffr

Apply

Vacancy posted 1 day ago

Similar jobs that could be interesting for youBased on the Medical Director, Utilization & Care Management in Nashville, TN vacancy

Home Health Clinical Manager
$25k
...Become a part of our caring community As a Clinical Manager at CenterWell Home Health,... ...reporting to the Branch Director, you will lead and support... ...documentation review, utilization review findings, and performance... ..., Humana provides medical, dental and vision...
Suggested
Full time
Temporary work
Apprenticeship
Work at office
Relocation package
CenterWell
Nashville, TN
3 days ago
Vice President, Medical Strategy Director
...Vice President, Medical Strategy Director About the Company AI-driven healthcare communications... ...clinical trial engagement value-based care consulting influencer marketing... ...transformative potential of AI. Hiring Manager Title Head of Medical Strategy...
Suggested
Confidential
Nashville, TN
2 days ago
Veterinary Medical Director
...specialty clinicians in the role of Medical Director. The Medical Director will... ...quality standards (patient care, client and referral... ...perks. Efficiency Tools: Utilize Talk-a-too and text expander... ...- our own built-in learning management system. ~ RECOVER CPR certifications...
Suggested
Temporary work
Summer work
Work at office
Relocation package
Flexible hours
Night shift
BluePearl Specialty and Emergency Pet Hospital
Nashville, TN
3 days ago
Medical Director
$227.6k
...part of a physician team, ensures that utilization management responsibilities are performed in accordance... ...cases electronically and using Medical Policy criteria sets to evaluate the medical... ...to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES...
Suggested
For contractors
Private practice
Work at office
Local area
Highmark Health
Nashville, TN
12 hours ago
Medical Director
$165 per hour
...Medical DirectorNashville, TennesseeSteadfast Health was founded... ...substance use disorder (SUD) care. Recognizing that traditional... ...mission – join us!The Medical Director provides clinical supervision... ...trusted clinical resource to APPs managing complex substance use,...
Suggested
Part time
Local area
Steadfast Health
Nashville, TN
1 day ago
Assistant Manager - Clinical - Chennai/Cochi
Introduction:At Fresenius Medical Care, we are the global leader in kidney care, committed to improving the lives of patients with chronic... ...and help shape healthcare worldwide!Job SummaryThe Clinical Manager is responsible for planning, executing, and overseeing clinical...
Full time
Local area
Worldwide
Fresenius Medical Care
Nashville, TN
1 day ago
Medical Field Case Manager
$70.6k - $80k
...on workers’ compensation case management training. Join our... ...services, achievement of maximum medical recovery and return to an optimal... ...treating physicians/providers and utilize available resources to help... ...Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room...
Full time
Part time
Local area
Remote work
Home office
Flexible hours
Enlyte
Nashville, TN
3 days ago
Licensed Clinical Social Work Supervisor (LCSW)-Nashville West
...work and provide better client care! Who we are looking... ...flexibility to set their own schedule, manage their own caseload at a... ...gaps in our community Utilize creativity in interventions to... ...managers, families, work personnel, medical personnel, other Ellie staff,...
Hourly pay
Full time
Part time
Work at office
Local area
Work from home
Flexible hours
Ellie Mental Health - 027
Nashville, TN
4 days ago
Branch Director, Home Health
$93k - $128k
...Become a part of our caring community ***$10K Sign-On Bonus*** The Associate Director, Home Health Branch Administrator responsible... ...for administration and/or management of branches The Associate Director... ...our benefits, Humana provides medical, dental and vision benefits, 40...
Full time
Temporary work
Apprenticeship
Work at office
Local area
Relocation package
CenterWell Home Health
Nashville, TN
18 hours ago
Area Practice Manager - Brentwood TN
...Description Job Description Great patient care takes a great team behind it. Help ours... .... We’re looking for an Area Practice Manager who can bring people together, keep busy... ...registration, scheduling, patient calls, and medical records. Plan staffing coverage around...
Full time
Temporary work
Work at office
Immediate start
Monday to Friday
QualDerm Partners
Brentwood, TN
3 days ago
Clinical Social Work Supervisor, MN/ND
...Multi-State Outpatient Behavioral Health Program Psychiatric Medical Care is seeking an experienced Clinical Social Work Supervisor... ...knowledge of clinical practice, documentation, ethics, and risk management Ability to maintain accurate supervision and licensing...
Psychiatric Medical Care LLC
Brentwood, TN
12 days ago
Case Manager, Clinical Services
$20.05 - $28.1 per hour
...Case Manager Jump start your career in the mental health field as a Case Manager. You'll coordinate services and care for patients – providing coaching, strategies and coordination of... ...written documentation into Electronic Medical Record in a timely manner for all services...
Full time
Work at office
Flexible hours
Centerstone
Madison, TN
1 day ago
Medical Director, Orthopedic Surgery - Remote
$248.5k - $373k
...,500 - $373,000/yearJob Area: Medical & Clinical OperationsCompany:... ...global organization that delivers care, aided by technology to help... ...team at Optum, the Medical Director provides leadership, organization... ...:Experience working for a managed care organizationExperience with...
Minimum wage
Full time
Work experience placement
Work at office
Local area
Remote work
UnitedHealth Group
Nashville, TN
18 hours ago
Assistant Clinic Director (RN)
...Full-time & Part-time Assistant Clinic Director to support the management and daily operations of our clinic... ...overseeing staff, ensuring excellent client care, driving client retention, supporting... ...Microsoft Office Electronic Medical Records (EMR) systems Anatomy, medical...
Full time
Part time
Work at office
Local area
Monday to Friday
Shift work
Weekend work
ivnutrition
Nashville, TN
4 days ago
President & General Manager, Health Systems
...President & General Manager, Health Systems About the Company Highly innovative telemedicine company Industry Medical Practice Type Privately Held, VC-backed Founded... ...pivotal in bringing personalized, proactive care into homes, particularly for seniors...
Confidential
Nashville, TN
1 day ago
Medical Field Case Manager
$70.6k - $80k
...Field Case Manager At Enlyte, we combine innovative technology, clinical expertise, and... ...healthcare services, achievement of maximum medical recovery and return to an optimal level... ...with treating physicians/providers and utilize available resources to help create and implement...
Full time
Part time
Local area
Remote work
Home office
Flexible hours
Mitchell International
Nashville, TN
1 day ago
Clinic Director, Physical Therapist (Donelson)
$20k
...and industrial rehabilitation care Developing "Great... ...leadership, problem-solving, and time management skills. Requires a... ...but not limited to Electronic Medical Record (EMR) system, database... ...Journal Clubs Clinical Director Training Opportunities for...
Temporary work
Local area
Flexible hours
Night shift
STAR Physical Therapy
Nashville, TN
10 days ago
Clinic Manager
...frontrunner in primary care by leveraging cutting‑... ...billing, and records management. Support Services Our... ...our Patient Centered Medical Home model to ensure all... ...approval of the Clinic Director and Executive Team,... ...reaching) to access and utilize required equipment, supplies...
Full time
Work at office
Day shift
Neighborhood Health
Nashville, TN
18 hours ago
Clinical Pharmacy Manager Cardiology and Surgery
...Clinical Pharmacy Manager Cardiology and Surgery Vanderbilt University... ...Teams. Improve Patient Care. Vanderbilt Health is... ...is passionate about advancing medication safety, developing high-performing... ...Team Lead, Residency Program Director, or similar leadership role...
Temporary work
Immediate start
Vanderbilt University Medical Center
Nashville, TN
1 day ago
Hospital Laboratory Director
...Hospital Laboratory Director TriStar ***... ...information for patient care. Our infrastructure includes... ...and performance management. Develops and recognizes... ...monitoring resource utilization, identifying variances... ...Degree in Medical Technology, Biomedical...
Full time
Local area
Relocation package
First Connect Health
Nashville, TN
2 days ago
Home Health Registered Nurse Case Manager
$49 - $69 per hour
...Become a part of our caring community As a CenterWell Home Health nurse, reporting to the Clinical Manager, you will provide personalized, one-on-one care that helps patients... ...in their homes, including administering medications, performing wound care, and conducting patient...
Full time
Temporary work
Apprenticeship
CenterWell Home Health
Nashville, TN
2 days ago
Hospice RN Case Manager
$74.17k - $84.89k
Overview Hospice RN Case Manager / Registered Nurse - HealthCare Support is seeking a Hospice... ...or facility visits to provide patient care. Collaborate with an NP, RN team,... ...wound care, monitor vitals, administer medications, and perform pronouncements of death as...
Local area
Immediate start
Monday to Friday
Night shift
HealthCare Support
Nashville, TN
1 day ago
Licensed Clinical Social Worker-Supervisor
...health and innovating ways to provide accessible, high-quality care. Our clinics aim to eliminate obstacles in mental health... ...per week (including supervisees). Coordinate with case managers, families, medical personnel, and other staff as needed. Attend clinical meetings...
Work at office
Flexible hours
Ellie Mental Health - 027
Brentwood, TN
9 days ago
Manager of National Health Systems
$185k - $325k
...Job Description About Ceribell Ceribell is a medical technology company focused on transforming the diagnosis and management of patients with serious neurological conditions. The Ceribell System is a novel, point-of-care electroencephalography ("EEG") platform...
Contract work
Local area
Flexible hours
Ceribell, Inc
Nashville, TN
10 days ago
Medical Director
Join us as a Medical Director at VCA Decatur Animal Hospital. You'll quickly discover that you'... ...practice focuses on providing comprehensive care for dogs and cats. Routine wellness to... ...of associates assigned to this job. Management reserves the right to revise the job...
Full time
Relocation package
Monday to Friday
Vicar Operating, Inc. dba VCA
Nashville, TN
5 days ago
HOSPICE REGISTERED NURSE CASE MANAGER
$85k - $90k
...Description HOSPICE REGISTERED NURSE CASE MANAGER Davidson County, Tennessee... ...delivering compassionate, high-quality care in the patient's home. The organization... ...assigned hospice patients. Administer medications and treatments as prescribed by the physician...
Full time
Local area
Monday to Friday
Shift work
A Plus Hire Right Search Group LLC
Nashville, TN
1 day ago
Sr. Contracts Manager - Clinical & Surgical
Reference: PR/612976_1791225177Senior Contracts Manager - Clinical & SurgicalLocation: Nashville, TN (Hybrid - 4 Days In Office / 1... ...industry benchmarks to support strategic sourcing decisions.Analyze utilization data, spend reports, and contract performance metrics to...
Contract work
Work at office
Remote work
Relocation package
DSJ Global
Nashville, TN
9 hours ago
Medical Case Manager - Workers' Compensation
...return to work safely through coordinated, clinically appropriate care. Our name reflects our mission - Forza means "strength,"... ...ForzaCare and Ethos partnership here. Job Summary As a Field Medical Case Manager at ForzaCare, you'll help injured workers navigate their...
ForzaCare
Nashville, TN
4 days ago
Practice Success Manager
...that turn complex insights into better care for every patient. Our model blends clinical... ...We’re looking for a Practice Success Manager to serve as the front‑line partner for... ...improvement plans related to outcomes, utilization, and patient engagement. Identify and...
Remote work
Chamber Cardio
Nashville, TN
2 days ago
Health Care Research Manager - Deloitte Center for Health Solutions
$97.6k - $200.6k
...shaping the future of life sciences and health care? Deloitte’s Center for Health Solutions (... ...sector, particularly biopharma and medical technology organizations. The individual... ...and health care ecosystem. As a Research Manager at Deloitte, you will: Shape market-moving...
Local area
Deloitte
Hermitage, TN
4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Medical Director, Utilization & Care Management. Be the first to apply!