director utilization management

The Director of Utilization Management is a transformational clinical operations leader responsible for delivering strategic and operational oversight for Utilization Management (UM) teams. This high-impact forward-thinking leader drives clinical and operational excellence across all UM functions, including prior authorizations, concurrent reviews, and...

Where You’ll Work Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution...

Opportunity Overview:  We are looking for physicians who have expertise in Internal Medicine including medical and surgical clinical areas to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.  Reporting to the Managing Medical Director for Cohere...

About the OpportunityWe are seeking an experienced Medical Director of Utilization Management in New York City to provide clinical leadership within our client’s growing health plan environment serving Medicare and Medicaid populations. This is an outstanding opportunity for a physician who enjoys collaborating across multidisciplinary teams, driving...

We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.About the Role:The Director of Utilization...

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.Excellence starts with our people.WE OFFERA competitive compensation packageBenefits include...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the...

Overview Unique opportunity to make a measurable impact on healthcare delivery and quality!Dynamic physician leader needed to champion FirstHealth’s Utilization Management efforts. We are a private, community-based healthcare system with four hospitals serving 15 counties in the mid-Carolinas. Our organizational culture is guided by a...

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care...

Integra’s Utilization Management (UM) division is looking for an experienced individual to direct the clinical and non-clinical utilization management teams for a managed care organization. This individual will play a key role in delivering UM to our health plan clients, growing our UM business, and working with the organization to...

Position Summary:The Director of Utilization Management at Palm will be responsible for overseeing the Referrals Department and RN Case Managers across our network of primary care clinics. This leadership role ensures that appropriate utilization of healthcare resources is aligned with company standards, regulatory requirements, and quality care practices....

Atlas Search is searching for an experienced Medical Director of Utilization Management in New York City. This role is pivotal in providing clinical leadership within our client’s health plan, serving Medicare and Medicaid populations. The ideal candidate will thrive in multidisciplinary collaborations, driving quality outcomes while ensuring compliance...

Title: Medical Director, Utilization Management (Commercial & MA)Start Date: 08/10/2026End Date: 02/10/2027# of Openings: 1Position Type: ContractLocations: Henderson, NVAdditional Details: This is a 6-9 Month contract with a possibility of an extension. -Fully remote opportunity -Looking for an immediate start Must Have:  -Utilization management experience...

POSITION SUMMARY/RESPONSIBILITIES This position provides clinical leadership and oversight of the population health management program including utilization management, case management, preventive health/disease management, and quality management while supporting the multidisciplinary member-centric approach to care management. Actively participates with...

Job DescriptionJob DescriptionStarling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials,...

Overview Under direction from the Director of Utilization Management, manages and provides direction to the Health Services department Managers for all product lines ensuring consistent development, implementation, and maintenance of health services programs and achievement of department goals and objectives, in a fast paced, ambiguous...

Community First Health Plans seeks a physician leader to oversee the population health management program, including utilization management, case management, preventive health and quality management. The role collaborates across the organization to promote integrated care and risk management.Requirements include an MD or DO with Texas license, at least five...

Who We Are - Motivated by Purpose. Powered by Clinical Expertise. Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. WE OFFER A competitive compensation package Benefits...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the...

Job DescriptionJob DescriptionStarling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials,...