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Medical Director – LTSS (DE)

Newark, DE

The Long Term Services and Support Medical Director will oversee and be responsible for all LTSS and execution of all health care affordability and clinical quality initiatives to achieve goals. The Medical Director is accountable for quality initiatives to improve HEDIS […]

Medical Director (SC)

Charleston, SC

The Medical Director will provide organizational leadership in the operational areas of utilization review, case management, quality improvement and related policy and practice initiatives. […]

Behavioral Health Medical Director (NJ)

New Jersey

The Behavioral Medical Director supports the Clinical Department by providing consultation regarding the clinical aspects of specific cases and offering guidance pertaining to best practice standards and quality of care […]

Behavioral Health Medical Director (PA)

Philadelphia, PA

The Behavioral Medical Director supports the Clinical Department by providing consultation regarding the clinical aspects of specific cases and offering guidance pertaining to best practice standards and quality of care […]

Psychiatric Medical Director (DE)

Delaware

The Psychiatric Medical Director supports the Clinical Department by providing consultation regarding the clinical aspects of specific cases and offering guidance pertaining to best practice standards and quality of care […]

Medical Director (PA)

Philadelphia, PA

The Medical Director will provide medical leadership for utilization management, cost containment, and medical quality improvement activities. […]

Medical Director (DC)

Washington DC

The Medical Director will provide medical leadership for utilization management, cost containment, and medical quality improvement activities. […]

Chief Medical Director (MI)

Detroit, MI

This position is responsible for providing medical leadership to the organization by ensuring medical quality and adherence to professional […]

Regional Medical Director (PA)

Philadelphia, PA

The Regional Medical Director provides medical leadership to a multidisciplinary regional team for utilization, prior authorization, provider relations and case management functions. […]

Medical Director – LTC (OH)

Columbus, OH

The Long Term Care Medical Director will oversee and be responsible for all LTC and execution of all health care affordability and clinical quality initiatives to achieve goals. The LTC Medical Director is accountable for quality initiatives to improve HEDIS […]

Medical Director – LTSS (FL)

South Florida

The Long Term Services and Support Medical Director will oversee and be responsible for all LTSS and execution of all health care affordability and clinical quality initiatives to achieve goals. The Medical Director is accountable for quality initiatives to improve HEDIS […]

Care Managers (CA, AZ, WA, TX, FL)

Various locations in CA, AZ, WA, TX, FL

Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. […]

Medical Director (KS)

Kansas City area, KS

Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. […]

Vice President, Medical Management – RN (IL)

Chicago area

Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures. […]

Behavioral Case Managers (FL, IN, NE, TX, AZ, WA)

FL; IN; Omaha; Tempe or Tucson, AZ; Various Washington and Texas locations

Perform duties related to the day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. […]

Lead Utilization Management – RN (FL)

Miami, FL; Remote possibility from Miami area

Gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria. Collects and analyzes utilization information. […]

Director Medical Management – RN (ME)

Portland, ME

This position serves as the leader for all clinical operations. The Director has primary responsibility to carry out all care coordination services. Accountabilities include all clinical operations, processes, programs, policies, procedures, documentation and reporting. […]

Supervisor, Utilization Management – RN (FL, KS)

Fort Lauderdale area, FL & Lanexa, KS

Supervise the daily operations of the utilization management (UM) department. […]

Director Case Management – RN (FL)

Jacksonville, Tampa and Fort Lauderdale areas, FL

Responsible for defining and directing a complete Case Management Program in conjunction with corporate goals and objectives. […]

Psychiatrist/ Medical Director – Behavioral Health (OH, AZ)

Ohio, Arizona

The Psychiatric Medical Director will assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. […]