Medical Director, Utilization & Care Management

Highmark Health

Highmark Inc. seeks a physician to join a multidisciplinary team to oversee utilization management, review escalated cases, and apply Medical Policy criteria to determine medical necessity. Telephonic peer discussions may be required to support clinical decisions, ensuring compliance with NCQA, URAC, CMS, DOH, and DOL standards. The role involves advising on high-risk cases, contributing to disease management programs, and participating in special projects to improve member care, with travel #J-18808-Ljbffr Highmark Health

Apply

Vacancy posted 1 day ago

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

Regional Medical Director - MD
...Description Overview The Regional Medical Director (RMD) reports to the Chief... ...region within Abode Care Partners. The RMD is accountable... .... The RMD directly manages Regional Clinical Directors... ...clinical workflows, quality, utilization, and growth. The RMD maintains...
Suggested
BrightSpring Health Services
Indianapolis, IN
a month ago
Behavioral Health Case Manager
$74.8k - $112.2k
...team of Behavioral Health Case Managers who are responsible for the... ...clinical information. They will utilize established clinical guidelines... ...claims contain quality of care issues and escalates these through... ...Rehabilitation, Consultants, Medical Nurse Reviewers, etc.) for proactive...
Suggested
Temporary work
Work experience placement
Work at office
Remote work
3 days per week
The Hartford
Indianapolis, IN
5 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
Indianapolis, IN
2 days ago
RN Case Manager, Hospice
...compassionate, quality comfort care that enhances the lives of... ...as needed (e.g., treatments, management of symptoms) following doctor... ...Organizes work schedule and utilizes time management to be able to... ...assigned by the Administrator/Director of Clinical Services. Qualified...
Suggested
Temporary work
Night shift
Weekend work
LIFE'S JOURNEY OF AVON, LLC
Indianapolis, IN
3 days ago
Hospice RN Case Manager
...patient-focused, provides the highest quality of care, family-oriented working environment with a non-corporate feel, managers and leadership who truly listen and follow up... ...to adequately assess and reassess pain. Utilizes appropriate pain management techniques. Educates...
Suggested
Full time
Work experience placement
Work at office
Local area
Monday to Friday
Paradigm Health
Indianapolis, IN
2 days ago
Skilled Home Health Care Manager (RN) Position Summary
The Skilled Home Health Care Manager (RN) is responsible for supporting and leading the growth of skilled home health services through... ...development activities to strengthen market presence and service utilization. * Skilled Home Health Services Growth: Promote BrightStar...
Weekly pay
Daily paid
Full time
Flexible hours
Shift work
BrightStar Care of Indianapolis
Indianapolis, IN
2 days ago
Executive Medical Director, CardioRenal
$243k - $356.4k
...patients are waiting. We unite caring with discovery to help make... ...how health is understood and managed, and support the communities... ...renal portfolio. The Executive Director will report to the Senior... ...She will also engage external medical and scientific experts as needed...
Local area
Worldwide
Flexible hours
Eli Lilly and Company
Indianapolis, IN
22 days ago
Medical Director, Medical Management
$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...
For contractors
Private practice
Work at office
Local area
Highmark Health
Indianapolis, IN
1 day ago
Family Practice Residency Associate Director
...Indianapolis 5230 Lauth Medical Arts Building 5230 E Stop 11 Rd Indianapolis, Indiana 4... ...Residency is seeking a full-time Associate Director for our Program in Indianapolis, Indiana.... ...future physicians, advancing primary care education, and leading with purpose in a...
Full time
Local area
Franciscan Health
Indianapolis, IN
2 days ago
Director of Clinical Operations
...Director - Clinical Operations, Maternity ServicesOur leaders shape strategic initiatives,... ...Maternity Services, advancing exceptional care experiences for patients, families, and team... ...employers and the most comprehensive medical system in the state, our vision is to lead...
Aya Healthcare
Indianapolis, IN
4 days ago
Practice Manager of Operations
As a Practice Manager of Operations with Thorpe Creek Dental Care , you’ll be a valued business partner to the Doctor. This hard-working and motivated leader... ...leadership and business acumen in a dental or medical setting of at least two years. More About The Role Strive...
Work at office
Local area
Day shift
Heartland Dental
Fishers, IN
2 days ago
Senior Clinical Consultant
$79.1k - $158.2k
...will lead to achieved value. Manage ongoing relationships with clients... ...focusing on client success in utilizing Oracle's solutions. Through... ...which includes the following: # Medical, dental, and vision insurance,... .../Spouse/Child) # Health care and dependent care Flexible Spending...
Temporary work
Flexible hours
Oracle
Indianapolis, IN
3 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
Indianapolis, IN
6 days ago
Dental Practice Operations Leader
Heartland Dental is seeking a Practice Manager of Operations for Thorpe Creek Dental Care in Fishers, Indiana. You will partner with the Doctor to guide and... ...two years of leadership experience in a dental/medical setting, strong communication and leadership skills,...
Heartland Dental
Fishers, IN
4 days ago
Clinical Site Manager for Near Patient Care
$79k - $146.8k
...patient is unique. Our Clinical Development & Medical Affairs (CDMA) team drives innovation to... ...(IRB/EC/Health Authority).Develop and manage key study site documentation (e.g., Study... .../metabolic indications or Point of Care / Near Patient Care settings You demonstrate...
Full time
Local area
Relocation package
Roche
Indianapolis, IN
9 days ago
RN Home Health Clinical Supervisor
...A prominent home health care provider in Indianapolis seeks a skilled RN Clinical Supervisor to oversee a dedicated home health care team. The role involves ensuring quality care, managing patient cases, and compliance with health standards. Ideal candidates will have...
TRUCARING INC
Indianapolis, IN
3 days ago
Hospice Account Executive
...Indianapolis, IN 46214 Why join our Dignity Care Hospice team? We provide high-quality... ...capabilities, and center events Managing the electronic referral system for assigned... ...~ Paid Time Off ~ Insurance benefits (medical, dental, vision, life, and other voluntary...
Full time
Temporary work
Local area
CommuniCare Corporate
Indianapolis, IN
3 days ago
Home Health RN Clinical Manager
$25k
...Become a part of our caring community As a Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you support a team of dedicated clinicians who deliver compassionate... .... Among our benefits, Humana provides medical, dental and vision benefits, 401(k)...
Full time
Temporary work
Apprenticeship
Relocation package
Rotating shift
Humana
Indianapolis, IN
3 days ago
Clinical Coding Manager
$118.5k - $148.1k
...position is part of the Data Management Oncology organization and supports... ...and timely coding of medical and medication terms in clinical... ...position reports to Associate Director, Data Management.... ...activities within Coder Tool utilizing MedDRA and WHO Drug dictionaries...
Full time
Work at office
Remote work
Worldwide
Sumitomo Pharma
Indianapolis, IN
5 days ago
Hospice RN Case Manager
$80k - $85k
...specialties. As a Hospice RN Case Manager, you'll provide skilled nursing care and compassionate support to patients... ...Demonstrate proficiency in medication administration across all routes (... ...members, and the Hospice Medical Director Coordinate with social workers,...
Daily paid
Full time
Temporary work
Part time
Work at office
Monday to Friday
Weekend work
OPTIMAL CARE INC
Carmel, IN
3 days ago
Compassionate Hospice RN Case Manager
...Adoration Health in Indiana is seeking a dedicated RN Case Manager for hospice care. The role focuses on 1:1 patient care, coordinating pain control, and implementing individualized care plans in a home-based setting. The position involves comprehensive nursing duties...
Work from home
BrightSpring Health Services
Carmel, IN
4 days ago
Home Health RN Case Manager
$75k - $85k
...About Abby Care Making family care possible. At Abby Care, we are tackling... ...to join our team as a RN Case Manager. This role will report into the Director of Nursing in Indiana. This is a Full... ...PPO plan options to choose from for medical, vision, dental, life, and short‑...
Full time
Temporary work
Flexible hours
Night shift
Weekend work
Weekday work
Abby Care
Indianapolis, IN
12 hours ago
Clinical Supervisor
$75k - $85k
...compromise ethical standards, patient care, or the reputation of RCA.... ...staff and the Clinical Director. The Clinical Supervisor is also... ...treatment plans and service utilization in order to ensure the... ...trains and provides performance management feedback to employees (coaching...
Work at office
Local area
Monday to Friday
Night shift
Recovery Centers of America
Indianapolis, IN
4 days ago
Home Health RN Case Manager
...Overview Division Recruitment Director for CommuniCare's Home Health... ...Why join our Dignity Care Home Health team? We provide... ...Do as a Home Health RN Case Manager At Dignity Care Home Health ,... ...rehabilitative action Administering medications and treatments as prescribed...
Full time
Local area
Dignity Care Partners
Indianapolis, IN
12 hours ago
Hospice Patient Care RN Manager
Overview Advance Hospice Care. Lead Clinical Excellence. Inspire... ...seeking a dedicated Patient Care Manager to join our hospice team.... ...Reporting directly to the Executive Director or Administrator, you will... ...incoming phone referrals and medical concerns in a timely, compassionate...
Daily paid
Full time
Part time
Local area
Gentiva
Indianapolis, IN
1 day ago
Hospice Patient Care RN Manager
Overview: Advance Hospice Care. Lead Clinical Excellence. Inspire... ...seeking a dedicated Patient Care Manager to join our hospice team.... ...Reporting directly to the Executive Director or Administrator, you will... ...incoming phone referrals and medical concerns in a timely, compassionate...
Daily paid
Full time
Part time
Local area
Gentiva Hospice
Indianapolis, IN
3 days ago
Family Physician/Medical Director
$110k - $140k
...aerospace component manufacturer as a Quality Manager and enjoy career growth, exciting... ...Why join us? ~Up to $140k base salary ~Medical, Dental and Vision insurance (HMO & PPO)... ...certifications, audits, and compliance matters. ~Utilize statistical analysis (SPC) and data-...
Temporary work
Local area
Jobot
Indianapolis, IN
12 hours ago
Hospice Account Executive
At Dignity Care Hospice , we provide compassionate, high-quality end-of-life care that... ...believe that hospice care is not just about medical needs—it’s about emotional and spiritual... ...relationships with physicians, case managers, hospital and clinic staff, senior living...
Local area
Dignity Care Partners
Indianapolis, IN
1 day ago
Registered Nurse/ Home Health Manager
...qualified and experienced Registered Nurse (RN) – Home Health Manager to join our organization in Indianapolis, Indiana. This leadership... ...nursing services, ensuring the delivery of high-quality patient care, and supporting clinical excellence across the care team. The...
Flexible hours
INHOME SELECTIVE CARE LLC
Indianapolis, IN
25 days ago
Assistant Clinic Director - Paramedic or RN
$30 - $40 per hour
...Assistant Clinic Director ( Paramedic or RN ) Full-Time | IV Nutrition Carmel Help Build... ...client experiences, and personalized care. Our mission is to help people feel their... ...coaching, and mentoring team members. Help manage clinic workflow, inventory, quality...
Hourly pay
Full time
Shift work
IV Nutrition
Carmel, IN
more than 2 months ago

Do you want to receive more vacancies?

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