director-utilization management

Medical Director Of Utilization Management HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and...

CommunityCare HMO Inc. in Tulsa, Oklahoma, seeks a Director of Utilization Management to provide strategic and operational leadership for the health plan's Physical Health Utilization Management department reporting to the Chief Medical Officer. You will lead a large team, drive data-driven strategies to improve clinical appropriateness, affordability,...

Job Summary and ResponsibilitiesAs our Utilization Management (UM) Director, you will serve as the strategic leader responsible for the development, implementation, and oversight of the Utilization Management program. In alignment with the CommonSpirit Health Care Coordination model, you will provide expert direction to our staff while overseeing critical...

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the...

Director of Utilization Management (RN)- Hybrid Remote/Hybrid – 2 days per week in the office A growing healthcare organization is seeking an experienced Director of Utilization Management to lead its Medicare UM department. This is an exciting opportunity for a hands-on leader to oversee and develop the UM function as the department continues to...

Cambia Health Solutions is seeking a Manager of Utilization Management to lead a team of clinicians and staff across multiple plans. You will oversee prospective, concurrent, retrospective reviews and post-service audits, shape policies, and drive performance against regulatory standards.The role demands RN licensure, a strong clinical background, leadership...

Bring your hospital-honed clinical judgment to the Health Plan Utilization Management RN Manager opportunity in the Portland Oregon Metro Area—a meaningful next step for 2026 that connects patient advocacy, leadership growth, and community impact with the pursuit of supportive leadership, clinician-friendly technology, and Pacific Northwest quality of...

Job DescriptionJob DescriptionPosition 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...

GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate holds a Florida medical license (MD/DO), BS/ABMS board certification or eligibility, and...

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. Benefits include healthcare, vision, and dental insurance Paid vacation, PTO, and holidays Growth and training...

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...

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...

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...

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. Benefits include healthcare, vision, and dental insurance Paid vacation, PTO, and holidays Growth and training...

Your Role The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Utilization Management - Appeals and Grievances is a key member of BSC's Clinical Appeals and Grievance...

Partnership HealthPlan of California is seeking a Licensed Registered Nurse to lead the Utilization Management department. The role requires directing UM managers, coordinating with multiple departments to address quality of care, and producing annual performance reports.Qualified candidates will have at least five years of clinical experience, three years...

This role is fully remote and must be located within the 50 U.S. states. Standard working hours are in Eastern Timezone. Semi-annual travel may be required to a Devoted office for on-site work. A bit about this role: At Devoted, our mission is to dramatically improve the health and well‑being of our members by treating each of them like family. Devoted is...

Medical Director Utilization Management Location: Remote Preference EST or nearby Pittsburgh PA, NY, WV Duration: 6+ Months Contract Role with possible extension. Position Overview As part of a physician team, the Medical Director ensures utilization management responsibilities are performed in accordance with the highest and most current clinical...

Director of Utilization Management (RN)- Hybrid📍 Remote/Hybrid – 2 days per week in the officeA growing healthcare organization is seeking an experienced Director of Utilization Management to lead its Medicare UM department.This is an exciting opportunity for a hands-on leader to oversee and develop the UM function as the department continues to...

Director of Utilization Management (RN)- Hybrid📍 Remote/Hybrid – 2 days per week in the officeA growing healthcare organization is seeking an experienced Director of Utilization Management to lead its Medicare UM department.This is an exciting opportunity for a hands-on leader to oversee and develop the UM function as the department continues to...