Medicaid Medical Director — Utilization & Care Leadership
Humana
Humana is seeking a Medical Director to join our compassionate team in Providence, RI. In this crucial role, you will utilize your medical expertise to review health claims and address complex clinical scenarios while ensuring regulatory compliance. Your responsibilities will include engaging in utilization management, collaborating with internal teams, and determining the medical necessity of services provided. The ideal candidate will have an MD or DO degree, Board Certification, and significant clinical experience. This position offers a salary range of $223,800 - $313,100, with potential bonuses based on performance. #J-18808-Ljbffr Humana
Vacancy posted 23 hours ago
Similar jobs that could be interesting for youBased on the Medicaid Medical Director — Utilization & Care Leadership in Providence, RI vacancy
$248.5k - $373k
...Medical Director Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...Enterprise Clinical Services leadership and staff to establish,... ...clinical knowledge in various utilization management activities with a...SuggestedRemote jobMinimum wageFull timeWork experience placementLocal area$223.8k - $313.1k
...Become a part of our caring community The Medical Director relies on medical background... ...or those experienced in Utilization Review are encouraged to... ...Advantage, Managed Medicaid, or Commercial lines of... ...used only if approved by leadership. Employees who live and...SuggestedBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayWeekend workHumana
Providence, RI2 days ago$223.8k - $313.1k
...Become a part of our caring community The Behavioral Health Medical Director is responsible for behavioral health care... ...other reference sources Learn Medicaid requirements and understand how... ...services Experience in utilization management review and case management...SuggestedFull timeTemporary workApprenticeshipRemote workWeekend workHumana
Providence, RI4 days ago- ...Partnerships. Transform Care through Compassionate Hospice Leadership. In this... ...highest standards of medical practice. You will... ...Monitor pharmacy utilization, ensuring... ...or Hospice Medical Director Certification Board... ...Enrollment (PECOS) and Medicaid certification if required...SuggestedDaily paidFull timePart timeLocal area
Gentiva Hospice
Warwick, RI23 hours ago $300k - $400k
...Surgical Pathologist Medical Director Opportunity University Pathologists... ...operations to take on a leadership role within a well-established... ...in surgical pathology. Utilizing your Hematopathology expertise... ...to ensure seamless patient care. Working independently while...SuggestedLocal areaRelocation packageShift work- ...Medical Director Smithfield, RI - Smithfield, RI 02917... ...to provide clinical leadership and consultation to the... ...excellence, quality care in our provider network... ...inpatient and outpatient utilization review. These... ...Quality Committee, & Medicaid and Commercial Quality...Full timePart timeShift work
$79.1k - $158.2k
...focusing on client success in utilizing Oracle's solutions. Through... ...business development teams and leadership to uncover opportunities and... ...includes the following: # Medical, dental, and vision insurance... ...Employee/Spouse/Child) # Health care and dependent care Flexible...Temporary workFlexible hoursOracle
Providence, RI4 days ago- ...old . We believe exceptional care starts with exceptional team!... ...clinicians and staff to thrive. Your leadership will directly influence... ...restrain/hold/transport and utilize quick body movements as... ...furniture Must be able to administer medication to clients Job Type: Exempt,...Full timeTemporary workLocal area
Socket
Providence, RI3 days ago - Neighborhood Health Plan of Rhode Island is hiring a Medical Director to lead clinical excellence, ensure high-quality care in our provider network, and maximize member... ...include clinical strategy oversight, committee leadership, and ensuring compliance with health...
- ...old . We believe exceptional care starts with exceptional team!... ...clinicians and staff to thrive. Your leadership will directly influence... ...restrain/hold/transport and utilize quick body movements as... ...Must be able to administer medication to clients Job Type: Exempt,...Full timeTemporary workLocal area
$140k - $175k
...Medical Director Opportunity At Providence River Animal Hospital At Providence River Animal Hospital, we believe exceptional pet care starts with an exceptional team. We are seeking a compassionate... ...loan assistance. Local leadership, medical autonomy, and the backing...Local areaRelocation package- Upward Health is seeking a Medical Director to lead in‑home, multidisciplinary care teams, delivering 24/7 whole‑person care in patients' homes and communities... ...requires a proven track record in innovation, leadership, and clinical excellence, with 20% direct patient...Remote jobWork from home
$82.5k - $166.1k
...decisions and better patient care. We want people just as dedicated... ...on customer success in utilizing Oracle's solutions. Using... ...role engages with staff and leadership from Federal customers and members... ...includes the following: # Medical, dental, and vision insurance...Temporary workWork experience placementLocal areaRemote workFlexible hoursOracle
Providence, RI3 days ago$74.8k - $112.2k
...clinical information. They will utilize established clinical... ...when claims contain quality of care issues and escalates these through... ...of health. Supports the leadership team by demonstrating understanding... ...Rehabilitation, Consultants, Medical Nurse Reviewers, etc.) for...Temporary workWork experience placementWork at officeRemote work3 days per weekThe Hartford
Providence, RI1 day ago- ...SURGICAL CENTER INC seeks a Clinical Director to oversee day-to-day clinical operations, staff utilization, and resource planning in a... ...safe, high-quality patient care. Applicants should be... ...surgical or endoscopic background, leadership skills, and a commitment #J-1...
- South County Veterinary is seeking a Medical Director to lead medical quality and clinical excellence while mentoring associate doctors... ...a high‑performing team. The MD balances hands-on patient care with leadership, ensuring compassionate, evidence‑based medicine in a...
- Ocean State Endoscopy Ctr in Providence, RI seeks a Clinical Director to oversee daily clinical operations, coordinate OR activities, oversee... ..., current BCLS certification, and at least one year of ambulatory care management. #J-18808-Ljbffr Ocean-State-Endoscopy-Center
$78k - $85k
...practice dedicated exclusively to veterinary medical oncology. Built around the belief that focused care creates a better experience for pets,... ...to meet you. What You’ll Do Operational Leadership Partner with the Medical Director to match clinical goals with hospital operations...Local areaPet Cancer Center of Providence
Providence, RI4 days ago$90k - $120k
## Hybrid RN Clinical Care Manager - Seekonk, MAApplylocations:... ...eligible enrollees with complex medical, behavioral and social care... ...needs.* Oversee enrollee utilization of long-term services and supports... ...under both Medicare and Medicaid.* Provide education to members...Hourly payWork at officeLocal areaHome officeFlexible hoursWeekend workAfternoon shift- ...Medical Director of Primary Care Services Providence, Rhode Island At Providence Community Health Centers (PCHC), we're not just providing... ...comprehensive primary care services across our organization. This leadership position guides clinicians to ensure the delivery of...
Penobscot Community Health Care
Warwick, RI2 days ago - Physician / Internal Medicine / Rhode Island / Permanent / Medical Director of Primary Care in the Providence, Rhode Island Area Job Enterprise... ...health management needs of the assigned member panel and utilizing data/analytics in... SUMMARYUnder the direct supervision...Permanent employmentShift work
$95.26k - $157.21k
...transformational change. It demands the focused utilization of clinical & operational expertise, managing integrative processes, and strong leadership. The Clinical Engagement Project Manager... ...that deliver high impact & safe patient care for the entire care team to achieve high...Shift work$68.97k - $113.31k
...this role, you will analyze medical information, assess functional... ...Leader ,whoreportstoour Director, Clinical Services .... ...goals. Through skill-building, leadership development and philanthropic... ...alternative process that does not utilize AI Tools or would like to...Full timeTemporary workH1bRemote workVisa sponsorshipWork visaFlexible hoursGuardian Life
Providence, RI2 days ago- ...Hematopathologist / Medical Director Providence, RI Full-Time Job... ...Providence, Rhode Island. This leadership opportunity is ideal for an... ...highest standards of patient care, quality, and regulatory... ...interpretation in Surgical Pathology. Utilize Hematopathology expertise in...Full time
$65k - $75k
Clinical Supervisor for Family Care Community Partnership Clinical Supervisor for Family Care Community Partnership 5 days ago Be among... ...categories. Ensures all documents are in accordance with Medicaid and/or state department standards. Approves required documentation...Full timePart timeWork at officeLocal areaWork from homeFlexible hoursAfternoon shift$180k
Position Summary The Medical Director (MD) serves as the clinical leader... ...quality, exceptional patient care, positive client experiences... ...hands‑on clinical practice with leadership responsibilities, spending... ...workflows to optimize team utilization, ensuring team members work...Full timeLocal areaRelocation packageFlexible hours- ...services. JOB SUMMARY: The Family Care Community Partnership (FCCP) Clinical... ...modeling inclusive and solution-focused leadership. Champions professional growth by participating... ...by ensuring all documentation meets Medicaid and state regulatory standards, modeling...Full timePart timeLocal areaFlexible hoursAfternoon shift
Comprehensive Community Action
Cranston, RI23 days ago - ...Responsibilities Director of Clinical Services Opportunity... ...a part of our Senior Leadership Team. This position... ...form development and utilization to standardize... ...roll over) Excellent Medical, Dental, Vision and Prescription... ...inpatient acute care facilities, inpatient...InternshipLocal area
Universal Health Services
Attleboro, MA3 days ago - ...Clinical Manager (Full Time) Community Care Allianceseeksahighly motivated, client-... ...as 988 ClinicalManager. This is a unique leadership opportunity withinthenationwide988... ...sick time and holidays. ~ Comprehensive medical and dental coverage as well as voluntary...Full timeContract workFlexible hours
Community Care Alliance
East Providence, RI10 days ago $90.33k - $180.69k
...provides daily clinical and operational leadership for a specific surgical service line. This... ...staff support, and coordinated patient care in partnership with the Nurse Manager,... ..., and staff resources. Monitor service utilization trends and contribute to operational and...Shift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medicaid Medical Director — Utilization & Care Leadership. Be the first to apply!
Related searches
- remote medical coding supervisor Providence, RI
- health services manager Providence, RI
- occupational health manager Providence, RI
- clinical services director Providence, RI
- clinical nutrition manager Providence, RI
- associate director clinical operations Providence, RI
- director sr. director clinical operations Providence, RI
- medical director utilization management Providence, RI
- clinical data manager remote Providence, RI
- senior director clinical development Providence, RI