Managed Care Director Remote Jobs

Lead compliance efforts for a national health organization, overseeing audits, policy development, and fraud investigations. Manage compliance department and ensure adherence to regulatory requirement...

Seeking an Inpatient Care Management Medical Director to conduct acute level of care and length of stay reviews for medical necessity for members managed within the continuum of care. Remote position...

The Behavioral Medical Director in Florida will provide medical leadership for utilization management, quality improvement, and credentialing functions, collaborating with various teams and providers...

The Remote Behavioral Medical Director in California will provide medical leadership for utilization management, quality improvement, and credentialing functions, collaborating with various teams and...

The Medical Director in Claims Management at Humana uses their medical expertise to review clinical scenarios, make determinations on requested services, and communicate decisions to internal associat...

The Behavioral Medical Director is responsible for overseeing the Utilization Management Program and performing peer reviews while collaborating with Psychiatrists and other clinical professionals. Th...

The Remote Child/Adolescent Behavioral Medical Director assists the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions. The role...

The Manager of Care Coordination oversees care coordination activities for assigned members, ensuring that appropriate services are delivered and continuity of care is maintained. This role involves m...

The Medical Director at CarePlus is responsible for reviewing health claims and making determinations on service authorizations based on clinical guidelines and regulatory compliance. This role involv...

The Behavioral Medical Director will provide clinical oversight and direction to Optum's Care Engagement team, collaborating with psychiatrists and other healthcare professionals to improve health out...

The Director of Clinical Operations is responsible for overseeing multiple departments to ensure smooth center operations. This senior role partners with the Medical Director and General Manager to me...

Child / Adolescent Behavioral Medical Director position at Centene requiring a Medical Doctor or Doctor of Osteopathy with Board certification by the American Board of Psychiatry and Neurology, and a...

The Behavioral Medical Director is responsible for overseeing the Clinical Management Program, working with a team of Optum Psychiatrists and community Behavioral Health Providers. This role involves...

The Director, Care Services is responsible for managing Ryan White and other special programs, ensuring revenue generation and professional operation of third-party payer services. The role involves l...

The Senior Medical Director at Sharp Health Plan provides critical management and oversight for physicians to coordinate medical, behavioral health, and pharmacy needs of members. This position also i...

Zing Health is seeking a strategic-minded leader to oversee data operations and governance. The role involves leading data management processes, ensuring data accuracy, and fostering a high-performanc...

The Product Manager - Care Management at Highmark Inc. is responsible for defining the product's value proposition, vision, and execution plan. The role involves aligning with strategic partners, over...

The Medical Director in Claims Management utilizes their medical expertise to determine the authorization of requested services and levels of care, ensuring compliance with regulatory standards. The r...

Oversee behavioral health related projects and programs for the Foster Care program, develop and implement behavioral health programs and initiatives for the foster care populations...

The Behavioral Medical Director is responsible for overseeing the Utilization Management Program and performing peer reviews while collaborating with Psychiatrists and other clinical professionals. Th...

The Senior Director of Risk Adjustment Compliance Oversight provides strategic leadership in managing compliance with regulations related to Risk Adjustment across various health programs. This role i...

The Manager of Clinical Operations is responsible for overseeing the Clinical Operations team, focusing on Quality and Testing for Claims Editing and Payment Integrity. This role involves managing wor...

The Director, Network Management is responsible for overseeing network strategy, development, and management within the Health Plan Administration organization. This role involves driving network expa...

The Medical Director will support the Prior Authorization program for Medicare Advantage members, focusing on high-value procedures and ensuring quality care through evidence-based medicine. This remo...

The Manager of HCS Operations Support oversees operational teams in managed care clinical programs, ensuring compliance with regulatory standards and enhancing care quality. Responsibilities include s...