Director, Medical Management & Utilization Review
Listed on 2026-10-16
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Doctor/Physician
Medical Doctor, Chief Medical Officer / Medical Director, Healthcare Consultant, Internal Medicine Physician
Highmark Inc. seeks a physician to lead utilization management within a CMDM team. You will review escalated cases against medical policy criteria to determine medical necessity, participate in peer discussions, and ensure compliance with NCQA, URAC, CMS, DOH and DOL.
Active medical licensure, board certification, 5 years in clinical care, and an MD/DO degree are required. Office-based role with 0–25% travel.
We are seeking a motivated Director, Medical Management & Utilization Review to join Highmark Health in Phoenix, AZ, United States.
Join Highmark Health and contribute to our ongoing work.
Take a moment to read everything above and see whether this role is right for you.
This posting is for the Director, Medical Management & Utilization Review role at Highmark Health, based in Phoenix, AZ, United States.
We are looking to fill the Director, Medical Management & Utilization Review position at Highmark Health in Phoenix, AZ, United States.
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