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Director Operations
DPDHL
Westerville, OH
Our ideal Operations Director has a full understanding of the importance of customer relationships – including the crucial role of the General Manager, Operations Managers and front-line…
Added just now
Sr Director Privacy & AI Legal
Dexcom
San Diego
You are able to work in person in the San Diego office 2-3 days per week and as required, local within 75 miles is strongly preferred · You must live within commuting distance of your assigned Dexcom site (typically 75 miles/120km)
Added 2 mins ago
VP - Real Estate Corporate Banking - Credit Delivery
Truist Bank
Atlanta, GA
…and coordination with deal team including the Relationship Manager, Portfolio Manager Team Lead, internal or external counsel and Credit approval…
Added 2 mins ago
VP - Real Estate Corporate Banking - Credit Delivery
Truist Bank
Atlanta, GA
…and coordination with deal team including the Relationship Manager, Portfolio Manager Team Lead, internal or external counsel and Credit approval…
Added 2 mins ago
Senior Revenue Operations Manager
Pallet
Remote, United States
You could be a Senior Revenue Operations Manager anywhere. Why Pallet?
Added 3 mins ago
Site EHS Manager III
Amazon.com Services LLC
Lansing, MI
…operate. We’re seeking a dedicated Workplace Health & Safety (WHS) Manager to help drive this mission forward. As our next WHS Manager, you'll be more than a safety professional – you'll be…
Added 3 mins ago
WF
Assistant Manager
WINDSOR FASHIONS LLC
Fargo, ND
- $17 to $20 USD / hour
As a Windsor Assistant Manager you are a key member of our store leadership team. You support the
Added 4 mins ago
MT
Principal Account Manager, Hyperscaler
Micron Technology
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- $142,800 to $287,700 USD / year
JR117343 Principal Account Manager, Hyperscaler
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Senior Director, ITP AI Data Platform and Infrastructure
Micron Technology
San Jose
- $239,000 to $472,000 USD / year
…Infrastructure to lead the strategy, architecture, engineering, and operations of the data and developer platforms that power AI across Micron’s Innovation, Technology and Products (ITP)…
Added 4 mins ago
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Project Engineer
Actalent
Wildwood, FL
- $31 to $43 USD / hour
…scheduling, subcontractor coordination, cost tracking, and field operations, while benefiting from strong mentorship, clear career progression, and exposure to large-scale roadway, utility,…
Added 4 mins ago
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Project Engineer
Actalent
Wildwood, FL
- $31 to $43 USD / hour
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Added 5 mins ago
Seasonal Associate - Famous Footwear
Famous Footwear
POTTSTOWN, PA
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Added 5 mins ago
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IT Business Analyst/Project Manager
Carver County
Chaska, MN
- $78,000 to $116,979.2 USD / year
Under the direction of the IT Manager - Project Management Office (PMO) the Business Analyst actively participates in the delivery of IT-related projects and enhancements supporting the…
Added 6 mins ago
DSP-RBT - Back-up Lead - CA
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United States
…and/or information; collects and enters data as part of daily operations using an electronic health…
Added 6 mins ago
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Quality Manager
Rivet Industries
San Jose, CA
- $175,000 to $215,000 USD / year
…frontline workers. We are looking for an experienced Quality Manager to build and lead quality across the company, from the first prototype through shipped product in the…
Added 6 mins ago
Assistant Manager II
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We’re seeking an Assistant Store Manager to join our team to help with store operations, customer service and team development. Duties include, but are not limited to, the following:
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Assistant manager II
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We’re seeking an Assistant Store Manager to join our team to help with store operations, customer service and team development. Duties include, but are not limited to, the following:
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Assistant Manager I
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Assistant Manager II
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Amerihealth Caritas

Per Diem Medical Director Utilization Management

United States

Apply on careers.amerihealthcaritas.com About employer

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Job details

Posting language: English
Posted: Nov 10, 2026

Original job description

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Job Summary Reporting to the Senior Medical Director of UM, the Per Diem UM Medical Director will be responsible for:

Performing daily medical reviews, appeals, participating in appeal panel as appropriate, correspondence regarding review determinations and physician peer review activities.
Identifying and implementing evidence-based practice guidelines throughout the provider network. · overseeing the quality of clinical care for network and non-network providers.
Utilizing evidence-based standards in making coverage determinations.
Management policies; meeting health plan inter-rater reliability guidelines.

Work Arrangement: Fully Remote Hours: Minimum of 10 hours a week and not to exceed 20 hours a week. Evening, weekend and holiday coverage required

Accountabilities:

Ensures the provision of quality and clinically sound services to all Enrollees by associates and Providers.
Serves as medical advisor and manager for all clinically related activities.
Assures that organization medical policies and procedures adhere to contractual obligations.
Performs clinical case reviews in conjunction with Medical Excellence Department.
Demonstrates knowledge of prescribed and established medical procedures and practices.
Maintains familiarity with federal, state and local regulations that may pertain to the medical and clinical operations.
Maintains compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and procedures, and contractual obligations.
Manages day-to-day operations and monitors the integration and processing of members to optimize appropriate use of behavioral and physical health services.
Participates with Quality Improvement and Medical Excellence in the identification and analysis of medical and behavioral health information to develop interventions to improve clinical effectiveness of medical management strategies.
Works closely with a multidisciplinary team to ensure behavioral health management and quality management programs are meeting contractual obligations.
Works with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff.
Attends case management meetings and monthly rounds as scheduled.
Collaborates with the integrated case management team, during scheduled meetings and informally as needed.
Thoroughly documents all care coordination activity in the member medical record in the electronic case management documentation system.
Adheres to AmeriHealth Family of Companies (ACFC) policies and procedures and supports and carries out the ACFC mission and values.

Education/Experience:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine licensed to practice as a medical director; additional state licensure required in all states where ACFC has a line of business, and that application is expected within 120 days of hire.
Must be Board Certified in a specialty with a current and unrestricted license.
Must be clear of any sanctions by the applicable state or Office of the Inspector General.
Must not be prohibited from participating in any Federally or State funded healthcare programs.
Minimum of 1 year of Health Plan experience.

Other Skills:

Strong written and oral communication skills-required.
Demonstrated competency in use of healthcare data.
Demonstrated excellent interpersonal communication skills and presentation skills.
Experienced in conflict resolution and negotiation.
Understanding of and expertise in quality improvement and medical economics.
Strong leadership skills.
Excellent analytical and problem-solving skills.
Demonstrated ability to access department’s work quality and develop / implement process improvements to achieve regulatory and oversight compliance.
Maintain current knowledge of and applies all applicable licensing, regulatory and industry standards.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Apply on careers.amerihealthcaritas.com About employer

More about this job

Skills

Regulatory compliance
Quality assurance procedures
Case management
Documentation
Communication skills
Presentation skills
Conflict resolution
Negotiation
Leadership
Problem solving

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Work requirements

Jobs in the United States