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Medical Director Utilization Management Jobs in Puerto Rico

LifeLink

Referral Coordinator

Guaynabo, PR · On-site

$14.75 - $19.25/hr

... Medical Director On-Call (MDOC), other management staff, Family Care Coordinator (FCC), Transplant Coordinator (TC), In-House Coordinator (IHC) and other development staff. Key Responsibilities:

NeoMed Center Inc

Director of Nursing

Gurabo, PR · On-site

$24.69 - $26.07/hr

Director of Nursing - East Region Location: Gurabo, PR Employment type: Exempt, Full-Time Salary ... Manages staff schedules, distributes workload and coordinates with the medical team to prevent ...

NeoMed Center Inc

Director of Nursing

Gurabo, PR · On-site

$24.69 - $26.07/hr

Director of Nursing - East Region Location: Gurabo, PR Employment type: Exempt, Full-Time Salary ... Manages staff schedules, distributes workload and coordinates with the medical team to prevent ...

Lifelink Foundation

Referral Coordinator

Guaynabo, PR · On-site

$14.75 - $19.25/hr

... Medical Director On-Call (MDOC), other management staff, Family Care Coordinator (FCC), Transplant Coordinator (TC), In-House Coordinator (IHC) and other development staff. Key Responsibilities:

Boys & Girls Club

PACNA FINANCE ANALYST

San Juan, PR · On-site

FINANCE DIRECTOR STATUS : oFull time CLASIFICATION (FLSA): oExempt GENERAL DESCRIPTION: Provide ... Monitor the utilization of funds and compliance with the assigned budget. * Maintain updated ...

New

Pwc

SAP BRIM Consultant, Senior Associate

San Juan, PR

$77K - $202K/yr

... utilization of SAP CRM applications - Optimizing customer relationship management processes to ... PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation ...

Fresenius Medical Care

Float Biomed

Bayamon, PR · On-site

$22.75 - $30.25/hr

... manage the medical supplies required. How you grow or advance in your career: We believe in ... Senior Director Technical Services, overseen by a Vice President of Technical Services and ...

Journeys

Store Manager Puerto Rico

Bayamon, PR · On-site

Prior retail management experience preferred * 1-2 years retail sales experience * Excellent ... Genesco's employment practices will continue to be directed toward full utilization of all ...

Journeys

Store Manager Puerto Rico

Ponce, PR · On-site

Prior retail management experience preferred * 1-2 years retail sales experience * Excellent ... Genesco's employment practices will continue to be directed toward full utilization of all ...

Journeys

Store Manager Puerto Rico

Humacao, PR · On-site

Prior retail management experience preferred * 1-2 years retail sales experience * Excellent ... Genesco's employment practices will continue to be directed toward full utilization of all ...

Journeys

Store Manager Puerto Rico

Ponce, PR · On-site

Prior retail management experience preferred * 1-2 years retail sales experience * Excellent ... Genesco's employment practices will continue to be directed toward full utilization of all ...

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All JobsMedical Utilization Management JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Puerto Rico

Medical Director Utilization Management information

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What are the key skills and qualifications needed to thrive as a medical director utilization management?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Puerto Rico?

For Medical Director Utilization Management jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Medical Director Utilization Management jobs in Puerto Rico look for?

The top searched job categories for Medical Director Utilization Management jobs in Puerto Rico are:

Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution.

Referral Coordinator

LifeLink

Guaynabo, PR • On-site

$14.75 - $19.25/hr

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 17 days ago

Job description

Join LifeLink - Join a Life Saving Team!
About LifeLink
More than four decades ago, a visionary group of innovators, led by renowned nephrologist Dr. Dana Shires, made a life-changing commitment-to save lives through organ and tissue donation. From that bold beginning, LifeLink Foundation was established - founded with heart, purpose, and a mission that still guides us today.
What started as a nonprofit with big dreams has grown into a vision-driven organization of more than 700 dedicated professionals across west-central Florida, Georgia, parts of South Carolina, Puerto Rico, and the US Virgin Islands.
At LifeLink, we are united by our mission: To honor donors and save lives through organ and tissue donation.
Our vision remains clear: To maximize the gift of life while giving hope to donor families and transplant patients.
We are grounded in the values that shape our work and culture-Compassion. Excellence. Legacy. People. Quality.
If you're inspired by purpose, driven by impact, and ready to help save and heal lives, LifeLink is the place for you.
What You'll Do
As a Referral Coordinator, you will directly contribute to LifeLink's life-saving mission. Evaluate and respond to hospital referrals to determine a potential organ/tissue donor. Apply LifeLink's policies and procedures in performing and documenting the timeliness of referrals, response to referrals and provide direction to responding staff. Ascertain information to help facilitate the determination of potential donors, Brain Dead (BD), Donation after Cardiac Death (DCD) potential, medical suitably and order of priority/Next-of-Kin (NOK). Participate in call schedule rotation to ensure coverage of this position's responsibilities 24/7. Effectively communicate with Hospitals, Administrator On-Call (AOC), Medical Director On-Call (MDOC), other management staff, Family Care Coordinator (FCC), Transplant Coordinator (TC), In-House Coordinator (IHC) and other development staff.
Key Responsibilities:
  • Participate in the RC call schedule coordinating FCC/IHC/HD/TC for making an appropriate and timely onsite visit for referrals in collaboration with AOC.
  • Referral responsibilities will consist of but may not be limited to: referral evaluation; preliminary determination of suitability; verification of name, race, sex, DOB and location of next-of-kin, accessing Donor Registry; notifying the FCC and other on call team members of potential donor situations; review information on initial referral regarding donation process with hospital personnel with outline of plan; perform coding of closed referrals, donor cases, non-donor cases; perform DDR on a timely basis; participate in assigned meetings; merge of duplicate referrals.
  • Post initial referral: monitor referrals daily and more often if indicate; maintain documentation on active referrals (weblog); passing referral call to oncoming RC according to set protocols in order to assure all active referrals are up to date and followed appropriately; provide follow-up to appropriate Hospital Development Liaison, AOC/IHC/FCC or other vascular staff; follow up with Tissue Screener for referrals that are going to be immediately extubated, or with cardiac arrest and not a candidate for organ donation.
  • Receive and handle or appropriately triage miscellaneous calls from the call center (Positive cultures, ME, Family issues, etc.).
  • Assist when appropriate in the orientation of new staff at the direction of the Director of Recovery Services.
  • Meet deadlines for any assigned projects.
  • Participate actively in hospital development initiatives.
  • Apply for continuing education courses and seminars necessary to obtain appropriate CEUs to obtain/maintain certifications and licenses.
  • Participate regularly in OPO & departmental meetings.
  • Other duties as assigned by Director of Recovery Services or immediate supervisor.

Who You Are
  • Passionate about helping others and making a difference
  • Aligned with LifeLink's core values of Compassion, Excellence, Legacy, People, and Quality
  • Minimum of one year in a related LifeLink position and/or appropriate credentialing and experience.
  • Bachelor Degree in Nursing (BSN-RN)
  • Appropriate experience in a medical environment.
  • Completion of all requirements of the probationary level position or other related experience/position.
  • Demonstrated above average verbal communication skills and phone etiquette skills.
  • Availability to handle rotation of 24/7 call responsibilities and a work schedule that may require response to emergency back-up call coverage.
  • Extended working hours while on-call.
  • Current driver license with good verifiable driving record.
  • Understanding that confidentiality must be maintained, according to Foundation protocols.
  • Availability for local/State auto/air travel is required.
  • Variable/rotation on-call days/hours including nights/weekends/holidays depending on call schedule and call duration
  • A collaborator who thrives in a mission-first environment

Why LifeLink?
  • Be part of an organization with a legacy of saving lives and giving hope
  • Join a passionate and supportive team across Florida, Georgia, and Puerto Rico
  • COMPANY PAID Medical, Dental, Disability & Life Insurance
  • Generous COMPANY PAID Pension Plan for your Retirement
  • Paid Vacation, Sick Days & Holidays
  • Growth opportunities in a mission-driven, high-impact nonprofit
  • Work with purpose, knowing your efforts directly touch lives

Diversity, Equity & Inclusion
LifeLink is proud to be an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment that reflects the communities we serve.
Ready to Help Change Lives?
Your next career move could be the most meaningful one yet.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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