Medical Director, Utilization Management & Policy
MetroPlus
MetroPlus Health is hiring a Medical Director to oversee health care utilization management in New York. This role involves performance reviews, educating physicians, and supervising claim reviews to enhance care while managing costs. Candidates are required to hold a medical degree and have experience in managed care, along with a valid New York State medical license. The position emphasizes integrity, customer focus, and strong communication skills. #J-18808-Ljbffr MetroPlus
- A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands... ...compliance with national guidelines and company policies. Ideal candidates will have significant clinical...PolicyRemote jobContract workWeekend work
$200k - $225k
...Time | Hybrid Leadership Opportunity Total Compensation Range: $200k - $225k We are seeking an experienced Medical Director of Utilization Management to provide clinical leadership within a growing health plan environment serving Medicare and Medicaid...SuggestedFull timePrivate practice$174.07k - $374.92k
...York City Health + Hospitals is seeking a remote Medical Director (Behavioral Health) to lead a utilization management team. This pivotal role involves oversight of... ...ensuring quality care, and implementing medical policies. The ideal candidate will be a board-certified...PolicyRemote work$135 - $150 per hour
...Job Posting: Medical Director (Utilization Review / Peer-to-Peer) Location: Position is Remote (anywhere... ...innovation, interpret and shape medical policy, and impact healthcare quality on a... ...and fair decision-making. Appeals Management: Reviews and adjudicates member or provider...PolicyHourly payFull timeContract workRemote work- ...Title : Medical Director Location: Remote Duration : 7 months contract to hire Employment:... ...part of a physician team, ensures that utilization management responsibilities are performed in... ...cases electronically and uses Medical Policy criteria sets to evaluate the medical...PolicyContract workPrivate practiceRemote work
$227.6k
...Summary This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the... ...incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness...PolicyPrivate practiceWork at officeLocal area$190k - $200k
...We're seeking a board‑certified Medical Director (Internal Medicine or Family Practice) to... ...role is fully remote and focuses on utilization management (UM), quality review, and clinical oversight... ...unit as needed. Consult on SUD policy and MCM cases when required. Review 4...PolicyFull timeRemote work$227.6k - $385k
...is seeking a physician to join a dedicated team focusing on utilization management. This role involves managing escalated cases electronically... ...advising on cases. Minimum qualifications require a Medical Doctor or Osteopathic Doctor degree and 5 years in clinical...$238k - $357.5k
...Medical Director Oncology Optum is a global organization that delivers... ...Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal... ...ensure all clinically relevant policies and processes are informed...PolicyRemote jobFull timeWork experience placementLocal area$195.2k - $341.6k
Job Summary The Medical Director is responsible for supporting staff by... ...Participate in development of policies and procedures... ...improvement initiatives, case management activities and member safety... ...activities Assist in the review of utilization data to identify variances...PolicyRemote jobWork at officeWeekend workAfternoon shift- ...you’ll be doing The Regional Medical Director will perform a key role... ...institutions, community networks, and managed care communities Present... ...with all corporate policies and regulatory guidelines What... ...fluently to any audience Must utilize effective, professional communications...PolicyFull timeLive inWork at officeLocal areaHome office
$201.81k - $227.03k
...Medical Director Of Utilization Management Position: Medical Director of Utilization Management Location: 120 Broadway New York (Must Reside in NY/NJ/CT) Work Schedule: Full-Time Compensation: $201,807.75 - $227,033.72 Annual Salary A little about us...Full time- Crains Cleveland is seeking a Cardiovascular Utilization Management Reviewer to join their Utilization Management team. This role allows you to leverage your expertise in cardiology in a fully remote setting, contributing to case reviews and patient care improvement. Ideal...Remote jobFull timePart timeFlexible hours
$175k - $220k
...Description About the Job: As Director of Medical Strategy - VP, you will... ...collaboration, with efficient workflow management. Demonstrated leadership... ...staffing plans, department utilization, budgets, and resource... ...qualifications. It is the policy of IPG Health and any of...PolicyWork at officeLocal area$220k - $290k
...equity and access for all. The Associate Medical Director will provide psychiatric care to... ...Provide psychiatric evaluations, medication management, and crisis intervention at one or more... ...quality assurance, peer review, and policy development. Supervise and mentor psychiatric...PolicyPrivate practice- ...Primary Care Physician to serve as the Medical Director for a community health center. The... ...operations, program development and grant management. Required Qualifications ~... ...state regulatory standards and clinic policies and procedures Provides clinical guidance...PolicyPermanent employmentFull timeLocum
- MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting peer discussions, and guiding policy implementation. Candidates should possess a Doctor of Medicine or Doctor...PolicyRemote job
- Associate Medical Director - Staten Island University Hospital, Prince’s Bay Campus The Associate... .... They will establish and monitor utilization goals, lead clinical quality improvement... ...aligned with SIUH’s strategy and policies. Requirements and Ideal Experience Medical...Policy
- ...Description Job Description The Medical Director provides full scope of... ...interdisciplinary team to manage inpatients presenting with stroke... ...and their families. Utilizes evidence-based diagnosis and... ...complies with, all hospital policies and procedures, as well as pertinent...Policy
$250k - $275k
...held, multispecialty medical group in New York, providing... ...home support, care management, and in-home care... ...Home Regional Medical Director is an important member... ...for implementation of policies related to care of the... ...activities including utilization review and case management...PolicyWork at office- ...culturally diverse communities in Queens, New York seeks, a medical director of the Advanced Primary Stroke Program. This is a full-time physician... .... Advocates for patients and family members, by designing policies and services that promote patient rights and optimal...PolicyFull timeImmediate start
- Associate Medical Director - Staten Island University Hospital, Prince’s Bay Campus Northwell... ...key role in establishing and monitoring utilization goals for the hospital. The successful... ...with the overall needs, strategy, policies and procedures of SIUH and the Health...PolicyWork at officeLocal area
- ...Search by Job Family Viewing: Regional Medical Director - Midcentral and Northeast Territory... ...with treatment guidelines and policies across medical programs, accrediting... ...practitioners, improve quality of care, manage utilization and infection control, and deploy clinical...Policy
$170k
...SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the... ...incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness...PolicyFor contractorsPrivate practiceWork at officeLocal area$227.6k
...under direction by the chief medical officer and in collaboration with the senior director for behavioral health, works... ...part of the behavioral health utilization management team and assists utilization... ...Highmark Wholecare’s and HHO WV policies and NCQA standards. Develop a...PolicyFor contractorsWork at officeLocal area- ...developing a new Diagnostic Medical Sonography Associates... ...Dean/Program Director to guide the development... ...Plans, administers, manages, and evaluates the Diagnostic... ...environment that utilizes face-to-face and digital... ...Sonography Program policies and procedures in collaboration...PolicyFull timeWork at officeLocal areaRemote workMonday to FridayFlexible hoursAfternoon shift
$120 - $135 per hour
...initially meet the applicable medical necessity guidelines,... ...of the request. Utilize medical/clinical... ...compliance with SBU’s policies/procedures, as well as... ...assist the Senior Medical Director in research activities... ...related to the Utilization Management process,...PolicyWork at office$120 - $135 per hour
...culture. What You’ll Be Doing As a Cardiology, Field Medical Director you will be a key member of the utilization management team. You can enjoy better work‑life balance on... ...utilization and compliance with SBU’s policies/procedures, as well as URAC and NCQA guidelines...PolicyWork at officeImmediate start- A health insurance provider is seeking a Medical Director in Pennsylvania to oversee clinical utilization management activities. This independent contract role requires at least five years of clinical experience and three years in managed care. Responsibilities include...Contract workPart time
$170k - $352.5k
A healthcare management organization in the United States is seeking a physician to join their utilization management team. This role involves reviewing escalated cases, ensuring compliance with medical standards, and advising a multidisciplinary team on high-risk cases...
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