Medical Director, Utilization Management
3 weeks ago
Your Role The Medical Director is a key member of the Medical Management team within the Healthcare Quality and Affordability business unit. This is a front-line utilization management position that has core responsibilities in inpatient concurrent review, pre and post service utilization review, and collaboration with RN Case and disease managers. This director position will report to the Sr. Medical Director, Medical Management. Your Knowledge and Experience Medical degree (M.D./D.O.) A minimum of 3 years of experience working for a Medical Group, IPA, or Health Plan making decisions for Medicare Advantage utilization is preferred but not required. A minimum of 5 years direct patient care experience post residency. Active recent hospital experience (within the past five years) is desirable. Strong clinical skills with prior experience in a primary care setting. A medical degree (MD or DO) with 5 or more years of clinical experience, preferably in a managed care setting with hospital experience, since a large part of this position involves inpatient con-current review. Completed residency preferably in adult based primary care specialty (e.g., Internal medicine, Family practice). Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required Maintain Board Certification in one of ABMS or AOA recognized specialty required (preferably Internal Medicine or Family Practice) Demonstrated proficiency in at least three of the following: MEDICARE/MEDICARE STARS Dual Special Needs Plan (D-SNP) MEDI-CAL NCQA/URAC/Quality Programs Policies/Procedure development Clinical Subject Matter Expert for Litigation SIU/Waste/Fraud/Abuse Appeals/Grievances Case Management/Population Health Federal Employee Program (FEP) Education/Training (DELIVERS CME, CEU) Quality Improvement #J-18808-Ljbffr
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California, United States Oklahoma Complete Health Full timeA national healthcare organization is seeking a Medical Director to lead utilization management initiatives and oversee a team of medical directors. The role requires a Doctor of Medicine or Osteopathy with extensive clinical experience and management capabilities. You will ensure evidence-based care for members while working with cross-functional teams....
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Remote Medical Director: Quality
2 weeks ago
California, United States Arizona Complete Health Full timeA healthcare company is seeking a Remote-Medical Director to oversee medical management and quality improvement efforts. Responsibilities include providing medical leadership in utilization management, collaborating with clinical teams, and ensuring compliance with regulatory standards. The ideal candidate is a board-certified MD or DO with experience in...
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Remote Medical Director
2 weeks ago
California, United States Oklahoma Complete Health Full timeA healthcare organization is hiring a Full time Medical Director responsible for directing medical management and quality improvement initiatives. The ideal candidate will have an Oregon license (preferred), experience in Utilization Management, and medical leadership skills. Competitive salary ranges from $210,800 to $400,500 annually along with...
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Director of Medical Management
2 weeks ago
California City, United States Highmark Health Full timeA healthcare organization is seeking a physician to join a team responsible for utilization management. The role includes reviewing medical necessity for treatments and participating in a multidisciplinary team approach for case and disease management. The ideal candidate should have an MD/DO, significant clinical experience, and excellent communication...
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Medical Director
3 weeks ago
California, United States Centene Corp. Full timeMedical Director page is loaded## Medical Directorlocations: Remote-NYtime type: Full timeposted on: Posted Todayjob requisition id: 1578153You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering...
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Medical Director
2 weeks ago
California, United States Oklahoma Complete Health Full timeMedical Director page is loaded## Medical Directorlocations: Remote-ORtime type: Full timeposted on: Posted Todayjob requisition id: 1617853You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering...
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Remote Medical Director
2 weeks ago
California, United States Centene Corporation Full time2 days ago Be among the first 25 applicants You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. We’re Hiring Remote Medical...
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Per Diem Medical Director
3 weeks ago
California, United States Altais Inc. Full timePer Diem Medical Director page is loaded## Per Diem Medical Directorlocations: Remotetime type: Part timeposted on: Posted 27 Days Agojob requisition idAbout Altais:At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and...
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Remote- Medical Director Arizona
2 weeks ago
California, United States Centene Corporation Full timeOverview Join to apply for the Remote- Medical Director Arizona role at Centene Corporation. You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace...
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Remote-Medical Director Arizona
2 weeks ago
California, United States Arizona Complete Health Full timeJoin to apply for the Remote-Medical Director Arizona role at Arizona Complete Health You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace...
