Medical Director, Utilization & Care Management
$227.6k - $385kHighmark Health
Highmark Health is seeking a physician to join a dedicated team focusing on utilization management. This role involves managing escalated cases electronically and ensuring compliance with clinical standards. Responsibilities include conducting reviews, participating in multidisciplinary teams, and potentially advising on cases. Minimum qualifications require a Medical Doctor or Osteopathic Doctor degree and 5 years in clinical care. A competitive salary range of $227,600 - $385,000 reflects the seniority of this role. #J-18808-Ljbffr Highmark Health
$85k - $106.3k
...and cost-effective health care services. Manages providers, members, team, or... ...manager generated requests for medical services and renders... ...and discharge planners in utilization tracking, care coordination... ...services or consults with medical directors when case does not meet...SuggestedWork experience placementFlexible hoursWeekend work$78.5k - $90k
A leading behavioral health facility in New York City seeks a full-time Care Manager for Behavioral Health. This role focuses on conducting managed care and utilization management reviews, optimizing patient experiences from admission to discharge. The ideal candidate...SuggestedFull time$78.5k - $90k
...position and join us in building on our legacy of world-class patient and family-centered care by taking your career - to the next level. Care Manager Behavioral Health - Utilization Management In this role, the Care Manager conducts managed care and utilization...SuggestedFull timeMonday to FridayShift workDay shift$120k - $165k
...At PetVet Care Centers, our mission is to improve the lives of animals... ...work closely with the Hospital Manager and Regional Manager. We are also open to a Medical Director role for an experienced DVM... ...Continuing Education: Commitment to utilize available resources of...SuggestedFull timeLocal areaRelocationFlexible hours- ...Medical Director-Ortho- CM & UR Brighton Health Plan Solutions REMOTE-100% PART TIME MANAGED CARE About The Role Brighton Health Plan Solutions, a full-service health plan administrator... ...interest and experience in managed care utilization and case management to support our team...SuggestedPart timeWork at officeRemote work
$150 - $165 per hour
...A healthcare consulting firm is seeking a Medical Director for a four-month engagement starting April 1. This role will provide clinical leadership in utilization management and oversee appeals related to Medicare Advantage and other lines of business. Responsibilities...Hourly payContract work- ...Medix™ is looking for experienced Utilization Management Medical Directors for a remote contract opportunity. This role is ideal for physicians with strong... ...certification, and significant experience in this field, making a direct impact on care quality. #J-18808-Ljbffr...Full timeContract workRemote workFlexible hours
$110.88 - $124.74 per hour
...A community-based healthcare organization is seeking a Medical Director of Utilization Management to oversee and coordinate clinical management, ensuring compliance with regulatory requirements. This role requires at least 3-5 years of health plan experience and a current...Hourly payDaily paidRemote workFlexible hours- ...Availity is seeking a Medical Director to lead the Utilization Management team for their Auth AI platform. Responsibilities include overseeing a team, ensuring the accuracy and validation of medical policies, and collaborating with cross-functional teams. Ideal candidates...Remote work
- ...A healthcare organization is seeking a Medical Director for Utilization Management to ensure compliant care decisions for Medicare Advantage members. This remote position requires expertise in clinical decision-making, particularly with MCG guidelines and utilization...Remote work
$275k
...Medical Director, Hematology/Oncology (Utilization Management & Clinical Strategy) Full-Time Remote (Post-Onboarding) U.S. Licensed MD/DO A nationally... ...role focused on utilization management, oncology care determinations, and strategic program development....Full timeRemote workRelocation packageMonday to Friday- ...Evolent is seeking an FMD in Radiology to play a crucial role within the utilization management team. The position involves reviewing imaging cases, ensuring compliance with medical necessity guidelines, and providing clinical rationale during peer-to-peer discussions...
$34.61 - $38.46 per hour
Samaritan Daytop Village in New York is seeking a Utilization Manager to support CASAC Counselors in delivering high-quality care. This role involves conducting utilization reviews, preparing reports, and providing supervisory support. Ideal candidates should have a High...Hourly pay$350k
...Careour tagline is “Where Care Comes Together.” As... ...held multispecialty medical group in the Bronx, we... ...home staffing and care management. Founded in 1999, our... ...Position title: Medical Director of Ophthalmology... ...planning, and resource utilization to ensure cost-effective...Work at office$250k - $350k
Overview Essen Health Care is a growing community... ...compassionate, and accessible medical care to some of the... ...telehealth. Our Care Management division supports... ...experienced GYN Medical Director to join our team. As... ...patient care plans Oversee utilization management activities...$250k - $350k
...Senior Regional Medical Director The Senior Regional Medical Director... ...their region with the goal of managing best practice performance as... ...cost-effective endovascular care across all service lines.... ...conversion, modality mix and utilization. Monitor and improve clinical...Work at officeRelocation package- ...A health insurance provider is seeking a Medical Director in Pennsylvania to oversee clinical utilization management activities. This independent contract role requires... ...clinical experience and three years in managed care. Responsibilities include conducting coverage reviews...Contract workPart time
- ...insurance company is seeking a qualified physician for a remote position focusing on clinical expertise and care management. Responsibilities include utilization review and ensuring compliance with clinical goals. Candidates must hold an MD or DO with at least 5 years of...Remote work
$190k - $200k
...A healthcare management company is seeking a fully remote Medical Director to support their team in utilization management and clinical oversight for high-volume cases. The ideal candidate will have an MD or DO with board certification in Internal Medicine or Family Practice...Remote work- ...highly organized, tech-savvy Case Management Coordinator to join our Case Management... ...with members to evaluate the medical needs of the member to facilitate... ...activities for Medicaid Long Term Care/Comprehensive Program enrollees. Utilizes critical thinking and judgment to...Contract workTemporary workWork at officeMonday to Friday
- ...Evolent is seeking a FMD, Radiology to join their utilization management team. This role requires serving as a physician match reviewer for imaging cases and ensuring compliance with medical review processes. Ideal candidates will have a minimum of five years' experience...
- Nemours Children's Health is seeking a Medical Director for our newly expanding Urgent Care Network in Glenn Mills, Pennsylvania!... ...culture that focuses on high quality care utilizing pathways and decision support tools in EMR. Manage clinical operations to ensure the...
$240.12k - $315.16k
Oscar Health is seeking an Associate Medical Director to join their Utilization Management Team. In this role, you will determine the medical appropriateness of various services, oversee a team of physicians, and influence departmental strategy while ensuring adherence...Remote jobImmediate start- ...Search by Job Family Viewing: Regional Medical Director - Midcentral and Northeast Territory... ...and find a career that supports: • Caring for overlooked, underserved, and vulnerable... ..., improve quality of care, manage utilization and infection control, and deploy clinical...
- ...Evolent is seeking a Vascular Surgery Field Medical Director to join our utilization management team. This role allows you to make a significant impact in patients... ...clinical license, and a passion for quality health care. We offer competitive compensation, including...
$176.6k - $294.3k
## Specialty Care Field Medical, Director, non-MDApplylocations: United States - New York - Remotetime... ...Leads advisory boards (BRF, Vendor) with manager oversight.* Field relevant inbound... ...technical skills* Rapidly adopt and utilize new digital technology and other resources...Permanent employmentH1bLocal areaRemote workVisa sponsorshipWork visaRelocation packageFlexible hours- ...A leading healthcare organization is looking for a Cardiology Field Medical Director. In this role, you will be pivotal in utilization management, conducting specialty reviews and providing clinical rationale for appeals. Required qualifications include an MD/DO degree...
- General Practice Care - Medical Director - Anderson, CA Anderson, United States | Posted on 05/15/2026 An exceptional veterinary hospital, with... ...for this hospital is a veterinarian who is prepared to manage a team of doctors and medical staff, and successfully oversee...Relocation package
- ...POSITION The Clinical Product Consultant for Utilization Management is a member of the Customer Success... ...years of clinical experience in acute care setting 2+ years of experience in... ...applicable) Customizable benefits package (3 medical plans with Health Saving Account...Live outLocal areaRemote workFlexible hours
- ...A leading healthcare facility in the United States seeks a Clinical Product Consultant for Utilization Management. The role involves providing clinical insights, ensuring product accuracy, and managing implementation milestones. Candidates should have a BSN, extensive...Remote workFlexible hours
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