Medical Director, Utilization & Quality Care
VNS Health
VNS Health seeks an experienced physician to guide utilization management for our members. You will review clinical information against evidence-based guidelines, render coverage decisions, and support internal and external teams with timely, compliant determinations. Requires Medical Degree and state license, 5+ years in clinical medicine with managed care; strong communication and decision-making skills. Board certification in Internal or Family Medicine is preferred; geriatric care experience #J-18808-Ljbffr VNS Health
$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into a strategic leadership position... ...You will oversee clinical strategy, quality improvement, and cost-effectiveness across... ...reviews and rationales in enterprise care management software. Join...SuggestedFull timeWork at officeRemote workMonday to FridayShift work2 days per week- Virtix Health LLC seeks a Medical Director to assess the quality of clinical services for Medicare beneficiaries... ..., and drive improvements in care delivery. After mentored training,... ...least one state, and experience with utilization management. #J-18808-Ljbffr Virtix...SuggestedRemote job
- HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage... ...of inpatient and post-acute care reviews, evaluating medical necessity... ...Certification by the American Board of Quality Assurance and Utilization Review Physicians...SuggestedFull timeRemote workMonday to Friday
- ...Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization... ...reviews for inpatient and post-acute care, ensuring medical necessity... ...responsible for regulatory compliance, quality initiatives, and collaboration with care...SuggestedRemote job
- CorroHealth, Inc. is seeking a highly skilled Medical Director to oversee the quality of clinical services for Medicare beneficiaries, ensuring CMS compliance and high standards of care. The role involves reviewing records, guiding clinical teams, and driving improvements...SuggestedRemote jobHourly payFlexible hours
- Geisinger in Pennsylvania seeks Physician Medical Director to lead medical management for Health... ...travel within the region. You will drive quality improvement, collaborate with Medical Home... ...monitoring to ensure optimal inpatient care and documentation. This position...
- ...Medicine as well as a proactive Medical Director for our Core Laboratory.... ...ensuring excellence in patient care through innovative... ...Lab operations to ensure high-quality diagnostic services and compliance... ...laboratory resource utilization and enhance patient care....Work at office
- A diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal...Remote jobFlexible hours
$275k - $315k
...conditions or life stages. By integrating primary care, mental health, gynecology, dermatology,... ...to improve care, designing system-wide quality improvement initiatives, and continuously... ...care model. Reporting to the Chief Medical Officer, you will leverage clinical data,...2 days per week- ...Center, Surgical Intensive Care Unit, regional Stroke... ...patients with high-quality service in a modern,... ...Responsibilities The Director of Quality Management... .... Ensures optimal utilization of resources and compliance... ...in reaching medical excellence. 11. Investigates...Monday to FridayShift work
- ...Description Job Description Director of Quality Management - Home Care Agency Make a Difference in Patient... ...Ensure proper release of patient medical records in accordance with HIPAA... ...the "minimum necessary" rule. Utilization Reviews & Audits: Supervise quarterly...Work at office
- ...largest public health care system in the nation.... ...health care systems in quality of and innovations to... ...jail services include medical, nursing, mental health... ...Island \n \n \n The Director of Infectious Disease... ...ID) needs through the utilization of electronic health...Full timeInternshipWork at officeMonday to Friday
$207.8k - $346.3k
...continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health... ...medical reviews that support high-quality patient care. Collaborate with healthcare... ...applicable state and federal laws, Utilization Review Accreditation Commission and...Remote jobWork from homeMonday to Friday- Oversee medical necessity reviews for home health, acute, post-acute, and outpatient services for Medicare Advantage populations... ...teams, and external agencies to promote evidence-based care and appropriate resource utilization. Apply CMS regulations, coverage determinations, MCG...Remote jobPart time
$172.9k - $230.5k
Overview Oversees the utilization of medical care and treatment of VNS MSO members and provides direction and guidance to the staff to assure appropriate and expedient decision-making with attention to quality of care. Consults and cooperates with internal and external...Work experience placementFlexible hours$190 per hour
Utilization Management Medical Director | Pennsylvania, New York, or West Virginia 110% Remote | Paying $190 - 2... ...dedicated nurses, pharmacists, and care managers who prepare each case before... ...workflow designed for efficient, high-quality case review Why Join? 100% Remote -...Full timeRemote workMonday to Friday$260k - $275k
Medical Director - Health Plan - Remote Salary Range: $260,000 - $275,000 per year Location: New... ...for supporting appropriate healthcare utilization through Utilization Management, medical... ...patterns to identify opportunities to improve care, reduce unnecessary costs, and address...Remote jobContract workMonday to Friday$270k - $320k
...it possible for AI to impact clinical care in a meaningful way. Tempus’ proprietary... ..., at the right time. We are seeking a Medical Director to join our Medical team leading the Tempus+... .... Engage Tempus+ sites with Lens utilization, molecular tumor boards, data integration...$83.1k - $120.36k
...Clinical Quality Manager The Clinical Quality Manager works with members and providers... ...role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare... ...recommend changes Reviews billing codes, medical records, and claims submission processes...Temporary workWork experience placement- ...entrepreneurs, starting in autism care. We help clinicians... ...City office. Role: Director of Clinical Quality and Outcomes We are hiring... ...progress rates, goal mastery, utilization, treatment fidelity,... ...including understanding of medical necessity, audits, and reimbursement...Full timeWork at officeRemote workFlexible hoursShift work
- ...Office Manager – Private Medical Practice Join a highly regarded... ...to exceptional patient care and a concierge approach to patient... ..., attentive, high-quality medical care. We also perform... ...be comfortable learning and utilizing new software platforms. Demonstrated...Full timePrivate practiceWork at office
- ...The Care Management Associate supports comprehensive coordination of medical services including Care Team intake, screening and supporting... ...care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services...Work at officeRemote work
- A leading healthcare organization is seeking a Neurologist Medical Director to ensure compliance with clinical guidelines for Medicare beneficiaries... ...case reviews, offering clinical guidance, and improving care delivery. Candidates must be board-certified and hold an...Remote jobFull time
$260k - $278k
...Position Overview: Establish, implement, and maintain the highest standards of professional medical care for the patients, and provide the medical leadership in identifying and implementing ambulatory care services that meet the needs of the patient population and community...- ...Alpha in their search for an Associate Medical Director in a remote capacity. Hello Alpha is seeking... ...Officer (CMO), provide direct patient care virtually on our telemedicine platform,... ...records in accordance with procedures utilizing our internal electronic health record...Full timeWork at officeRemote work
$198k - $210k
...schedule supports healthy, sustainable work-life balance? As the Medical Director of our ASPCA Community Veterinary Clinic, you’ll lead a mission-driven medical team expanding access to high-quality care for pets and families who need it most. This role combines hands-...Full timeWork experience placementWork from homeRelocation package10 hours per weekFlexible hoursShift workWeekend work- ...Reference 0000021852Salary Type AnnuallyIndustry HealthcareSelling Points Lead impactful healthcare initiatives as Medical Director, ensuring quality patient care. Shape clinic operations and policies while advancing professional growth. Drive excellence in a collaborative...
$160k - $180k
...timeCategory: Veterinary SpecialistPosted: 2026-07-21 Join us as a Medical Director at VCA High Peaks and you’ll quickly discover that you’re well... ...animal focus Who we look for People who love to care for and support our local pets. Dedicated experts who want...Full timeLocal area- ...full-time psychiatrist to serve as the Medical Director of Behavioral Health Services in the Institute... ...delivers holistic primary and specialty care to New York’s diverse and underserved... ...: Define clinical protocols, oversee quality assurance, and supervise psychiatrists,...Full timeTraineeshipWork at officeLocal area
$140k - $230k
...U.S. with a strong reputation for quality of care and research and education. Our health... ...contract performance through medication optimization, utilization management, quality measure achievement... ...complex patient population. The Director, Population Health Pharmacy, will...Full timeContract workTraineeshipLocal areaRemote workShift work
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