Remote Medical Director - Medicare Appeals Lead
CVS Health
- Remote job
Aetna, a CVS Health Company, is seeking a Medical Director to lead Medicare Part C appeals and oversee the appeals process. This remote role spans the US and requires an active medical license and board-certified specialty. You will supervise appeal nurses, participate in the Second Look Review, provide after-hours coverage, and collaborate with Medicare Quality and Compliance to improve policy implementation and appeals efficiency. #J-18808-Ljbffr CVS Health
$248.5k - $373k
...$248,500.00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... .... Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...Remote workMinimum wageWork experience placementLocal areaWork from home- A prominent healthcare organization is seeking an Appeals and Grievances Medical Director to manage clinical reviews of appeals for various health plans. The role offers flexibility to work remotely. Qualified candidates should have an MD or DO, be board certified, and...Remote job
- UnitedHealth Group is hiring for a remote-friendly clinical leadership role overseeing appeals and grievances across PPO, HMO, MAPD, and PDP products. The position emphasizes collaboration with medical directors and network management to improve access, quality, and outcomes...Remote job
- ...offering UnitedHealthcare services, invites an experienced clinician to join our remote team. You will review appeals, respond to regulatory bodies, and coordinate with medical directors to interpret benefits and access issues. The role requires an MD/DO with active license...Remote job
$207.19k - $295.99k
...healthcare solutions for diseases with high unmet medical need. Learn more at Astellas.com. Are you... ....Purpose and Scope:The Global Medical Lead (GML), Biopharma and Ophthalmology... ...EnvironmentThis position is based in Northbrook, IL. Remote work from anywhere in the US is available...Remote workWork at officeWork from homeWorldwide$236.5k
...clinical professional on our Medical Management/Health Services team... .... Assists Chief Medical Director in planning and establishing... ...clinical teams, network providers, appeals team, medical and pharmacy... ...flexible approach to work with remote, hybrid, field or office work...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work- A leading healthcare solutions firm seeks a Payment Integrity Supervisor to oversee daily... ...assurance measures and resolving provider appeals. The ideal candidate will also ensure compliance... ...on improving service delivery. This remote position requires strong experience in...Remote jobDaily paid
- Praxis, Inc. is seeking a Benefits & Appeals Platform Specialist for the GUST 23 project with Ohio Department of Job and Family Services. This role requires GSI platform expertise and experience in Ohio's public employment systems to support implementation and configuration...Remote job
- Centene Corp. is seeking a Remote Medical Director, Appeals to lead medical management, utilization review, and quality improvement for our national program. You will provide medical leadership across utilization management, cost containment, and clinical quality initiatives...Remote job
- ...for a high-level clinical specialist to review appeals and manage quality programs. This role offers remote work from anywhere in the U.S. and opportunities... ...regulatory responses, and communications with medical directors. Required credentials include an active MD/DO license...Remote job
- UnitedHealthcare is seeking a Medical Director to lead appeals and grievances review for multiple health plans. You will adjudicate cases, apply clinical... ...and ensure compliant, patient-centered decisions from a remote setting. This role requires MD/DO with active license,...Remote job
$191.5k - $355.6k
...Job SummaryThis position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts... ...internal medicince specialties preferred but nt required This is a remote work from home role #LI-MG1Are you being referred to one of our...Remote workFull timeWork at officeWork from home- A healthcare organization in Boston seeks a skilled Medical Director to oversee medical operations and clinical management. The role involves... ...a hybrid work model, balancing in-office presence with remote work opportunities. A commitment to patient-centered care and...Remote workWork at office
- UnitedHealth Group is seeking a physician leader to conduct case reviews for appeals and grievances across multiple health plans. The role involves regulatory responses, collaboration with medical directors, and guidance on benefit interpretations. You will participate in...Remote job
- ...in Virginia Beach region seeks a Director of Appeals and Grievance to plan, develop, and... ...across Commercial, Medicaid, and Medicare lines of business. This role leads program development, strategic... ...appeals reporting, collaborate with Medical Directors to adjust criteria, and...Remote job
- Centene Corporation is seeking a clinical leader to direct medical management, quality improvement, and credentialing for the Medical... .../Health Services team. You will partner with the Chief Medical Director to optimize utilization, cost containment, and care quality for...Remote job
- Real Chemistry seeks a Medical Director, Publications to lead scientific strategy and content across accounts, ensuring credible, compliant communications... ..., San Francisco, Carmel (IN), or Lambertville (NJ), or remote within the US. Role requires working eastern US hours...Remote work
$110k - $125k
A global healthcare agency is seeking a talented Associate Medical Director to lead the development of high-impact medical content. This role involves leveraging medical writing and scientific storytelling to enhance healthcare provider education and patient outcomes....Remote job- ...organized Manager of Clinical Appeals to lead our clinical appeals... ...background in clinical review, medical necessity denials, payer appeal... ...focus on government (e.g., Medicare, Medicaid) and commercial payers... .... ~ Experience managing remote and/or offshore teams (...Remote work
$11.41 per hour
...Snapshot The Contractor Medical Director (CMD) is responsible... ...Law Judge (ALJ) appeals hearings, and performing... ...collaborates with CMS and other Medicare Administrative... ..., we do offer remote work in the following... ...solutions company, is a leading not-for-profit health...Remote workHourly payFull timeContract workFor contractorsLive inLocal areaImmediate startShift work2 days per week- ...seeks a Manager of Clinical Appeals in New York. The role involves... ...commercial and government payers, leading a team, and ensuring... ...leadership, particularly in managing remote teams. The position requires... ...a thorough understanding of medical coding and payer processes....Remote work
- Real Chemistry is seeking an Associate Medical Director to join our growing medical communications team and lead the development of high-impact scientific content that... ...working eastern US hours and offers hybrid or remote options within the US. #J-18808-Ljbffr Real ChemistryRemote work
$110 - $130 per hour
Title: Medical Director Location: Remote Duration: 6 Months with possible extension/Conversion... ...physician to support the Medicare Inpatient Pod. This role... ...Chief Medical Director to lead utilization management,... ..., credentialing, and appeals for high-volume inpatient...Remote work$116k - $182.27k
...Job DescriptionJob Description Job Title: Lead Clinical Study Manager (Lead CSM) BU/... ...Management Location and Flex Work Arrangement: Remote Job Code/ Job Profile: not required for contractor 60099263 Supervisor: Associate Director/Director, Study Management Compensation...Remote workMinimum wageContract workFor contractorsLocal areaFlexible hoursNight shift$280k - $310k
A distinguished behavioral health organization seeks a Medical Director to lead psychiatric consultation and clinical innovation within the Collaborative... ...clinical experience and proven leadership skills. A fully remote position with a competitive salary range of $280,000 to $31...Remote work- ...Takeda is seeking a Lead Clinical Study Manager (LeadCSM) for remote work in the United States (Massachusetts virtual). You will lead cross-functional study execution, oversee budgets, and manage strategic partners/CROs to ensure on-time delivery of clinical programs....Remote work
- ...-Home Care team, is seeking a Home Health Study Manager to coordinate and manage contracted services for US studies in a remote role. You will lead study activities, train staff, liaise with sponsors and sites, ensure regulatory compliance (ICH/GCP/IATA/HIPAA) and deliver...Remote work
- ...Emmes is seeking a Senior Biostatistician Manager for a remote role to oversee statistical activities across various research areas. The role involves managing Biostatistician Managers, ensuring timely completion of projects, and serving as a client point of contact....Remote work
$328k
Job DescriptionGeneral Summary:The Executive Medical Director, Global Medical Lead (GML), Pain is a critical leadership role in Global Medical, responsible... ..., you can choose to be designated as: 1. Hybrid: work remotely up to two days per week; or select2. On-Site: work five...Remote workFull timeSummer workFlexible hours2 days per week- ...Hospital is seeking a Senior Healthcare Reimbursement Specialist to independently manage Medicare and Medicaid regulatory filings, compliance, audits, and appeals in a 100% remote role. Requires a Bachelor’s degree in Accounting, Finance, Healthcare Administration, or...Remote job
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