Remote Medical Director - Policy & Appeals Leader
HCSC Group
Health Care Service Corporation seeks a Medical Director for a remote, nationwide role. You will oversee assigned portions of medical policies and programs, perform medical appeals reviews, and collaborate with provider communities to improve policy effectiveness.
Candidates must be an MD/DO with a current US license, board certification, and at least five years of clinical experience. Strong analytical, communication, and strategic planning skills, plus proficiency in MS Office and Lotus Notes,
#J-18808-Ljbffr$236.5k
Position Purpose:Assist the Chief Medical Director to direct and coordinate the... ...and establishing goals and policies to improve quality and cost-... ...teams, network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or office work...Remote workPolicyFull timePart timeWork at officeFlexible hoursWeekend work$70.12k - $126.19k
...liaison for all statewide appeals, fair hearings, review... ...Details: This is a remote position. Hours are Monday... ...criteria to determine medical necessity of services... ...Coordinate with Medical Director(s) to clarify medical determinations... ..., and assist with policy and procedure reviews...Remote workPolicyHourly payFull timePart timeWork at officeMonday to FridayFlexible hours$248.5k - $373k
...Connecting. Growing together. Job Description - Appeals Medical Director - Radiology Required - Remote (2383588) Appeals Medical Director - Radiology Required... ...the application of clinical criteria of medical policies Perform Department of Insurance/Department of...Remote workPolicyMinimum wageFull timeWork experience placementWork at officeLocal areaWork from homeMonday to Friday- ...organized Manager of Clinical Appeals to lead our clinical appeals... ...in clinical review, medical necessity denials, payer appeal... ...medical necessity criteria, payer policies, NCDs/LCDs, and applicable CMS... .... ~ Experience managing remote and/or offshore teams (Philippines...Remote workPolicy
- ...seeks a Lead Coding Auditor for Itemized Bill Review and Appeals. This 100% remote role requires expertise in inpatient hospital bill auditing... ...hearings, and ensure billing is accurate and compliant with plan policies. As part of the mission, you will analyze documentation,...Remote workPolicy
$191.5k - $355.6k
...Remote IL - Chicago Full time R0055458 At HCSC, our employees are the cornerstone... ...is responsible for assigned aspects of medical policies and programs. Performs medical reviews... ...and their families. As an industry leader, HCSC also has been helping to make the...Remote workPolicyFull timeWork at officeWork from home- ...Job Title: Medical Director – Utilization Management Location: Remote Duration: 6+ Months Contract with possible extension... ...electronically using Medical Policy criteria sets to evaluate the medical... ...initial determinations, appeals, grievances, and other reviews as...Remote workPolicyContract workPrivate practice
$215k - $269k
...Medical Director - Physical Health Charllotte, NC (Primarily remote, no expectation to be in the office routinely, the selected... ...reviews, concurrent reviews, appeals, and level of care determinations... ...defined by approved Alliance policies, desk procedures, and workflows...Remote workPolicyPermanent employmentFull timeWork at officeWeekend work- ...Job Title: Medical Director – Utilization Management Location: Remote Duration: 6+ Months Contract with possible extension... ...electronically using Medical Policy criteria sets to evaluate the medical... ...initial determinations, appeals, grievances, and other reviews as...Remote workPolicyContract workPrivate practice
$102.18k
...Lead Appeals And Grievances RN Salary Range: $102,183.00 (Min.)... ...issues in alignment with L.A. Care policy and procedures along with all... ...&G cases. Analyze the patient medical records, clinical... ...weekends, holidays, a hybrid remote schedule, and occasional flexibility...Remote workPolicyShift workWeekend work$386.5k
...500/yearJob Area: Medical & Clinical OperationsCompany... .... The Medical Director, Clinical AI... ...senior physician leader responsible for the... ...to ensure medical policies are accurately interpreted... ...to work remotely * from anywhere within... ...from production, appeals, audits, and...Remote workPolicyMinimum wageFull timeWork experience placementLocal area- ...minded Clinical Claims Appeals Manager who is a... ...management, medical necessity review, or medical policy. This individual will... ...health plan medical directors, external review organizations... ...first-level appeal leaders and operational... ...in a desk or remote office environment....Remote workPolicyFull timeCasual workWork at officeAfternoon shift
$248.5k - $373k
...373,000/yearJob Area: Medical & Clinical OperationsCompany... ...at Optum, the Medical Director provides leadership,... ...and provider appeals. In addition, the Medical... ...and implementation of policies and procedures and clinical... ...flexibility to work remotely * from anywhere within...Remote workPolicyMinimum wageFull timeWork experience placementWork at officeLocal area$248.5k - $373k
...$373,000.00Job Area: Medical & Clinical OperationsCompany... ...at Optum, the Medical Director provides leadership,... ...and provider appeals. In addition, the Medical... ...and implementation of policies and procedures and clinical... ...flexibility to work remotely * from anywhere within...Remote workPolicyMinimum wageWork experience placementWork at officeLocal area$248.5k - $373k
...373,000/yearJob Area: Medical & Clinical OperationsCompany... ...at Optum, the Medical Director provides leadership,... ...and provider appeals. In addition, the Medical... ...and implementation of policies and procedures and clinical... ...flexibility to work remotely * from anywhere within...Remote workPolicyMinimum wageFull timeWork experience placementWork at officeLocal area$280.84k - $393.18k
...Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical Director... ...clinical requirements. This leader serves as the accountable... ...management, grievance and appeals, delegation oversight, and population... ...work schedule. (Mon & Fri - remote, Tues - Thurs onsite in...Remote workPolicyTemporary workLocal area- ...About The Role The Medical Director performs utilization review and medical... ...assignment. *This is a Remote Role Primary Responsibilities... ...specific criteria, and BHPS medical policy consistently, selecting the... ...that is defensible on appeal, external review, and audit....Remote workPolicyWork at officeLocal areaFlexible hours
- ...UnitedHealth Group is seeking a Medical Director to lead the Focus Claims Review team. The role ensures... ...provider telephonic discussions and appeals. Remote work is allowed within the U.S., with opportunities to shape policies and clinical criteria for programs. The candidate...Remote workPolicy
- ...enthusiastic and highly skilled Medical Director to join our growing team.... ...peer discussions. This is a remote position requiring a "roll... ...expertise, established medical policies, and evidence-based... ...all relevant regulations and appeal processes. Collaborate...Remote workPolicyFull timeFlexible hours
$222.75k - $267.3k
...Toland Physicians, Altais Medical Group Riverside, and... ...patients. The Medical Director of Utilization and... ...Utilization Management policy and procedures. This physician... ..., particularly thought leaders, across the One Altais... ...issues, response to appeals, attend HMO hearing on...Remote workPolicyWork at officeLocal areaFlexible hours$215k - $408.5k
...clinical professional on our Medical Management/Health... ...: Full time Medical Director for our Health Plan in... ...establishing goals and policies to improve quality and... ..., network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or...Remote workPolicyFull timePart timeWork at officeFlexible hoursWeekend work$195.2k - $341.6k
...Medical Director The Medical Director is responsible for supporting staff... ...review for clinical appeals cases Participate in the... ...Participate in development of policies and procedures Participates... ...Collaborate with market/product leaders to help define market...Remote workPolicyHourly payWork at officeWeekend workAfternoon shift$78k - $88k
...It takes great medical minds to create powerful solutions... ...Bill Review and Appeals who is responsible for... ...in accordance with plan policies and provider contract terms... ...in this role Fully remote (U.S.-based) Up to 25... ...Gainwell, an industry leader. You’ll be joining a company...Remote workPolicyFull timeContract workFlexible hours- ...retrospective reviews. As a Medical Director, UM you ensure all... ...and implement medical policies, procedures, and... ...Arrangement ~ Fully remote; must be willing to work... ...utilization management or appeals experience in a... ...generation of health care leaders. At AmeriHealth Caritas...Remote workPolicyContract workLocal areaFlexible hoursWeekend work
$170 per hour
...Medical Director Req number: R8700 Employment type: Full time... ...Worksite flexibility: Remote Who we are CAI is a global... ...escalated cases against medical policy criteria, which may include... ...of cases, review of appeals and grievances, and other reviews...Remote workPolicyHourly payFull timeApprenticeshipPrivate practiceWork at officeLocal areaWorldwide$225k - $300k
100% Remote, Medical Director Job Title: Physician-CW - Medical Director-CW Estimated full... ...Medical Necessity Reviews, Appeals & Grievances Peer-to-Peer experience... ...cases electronically and using Medical Policy criteria sets to evaluate the medical...Remote workPolicyFull timeContract workPrivate practiceFlexible hours$227.6k
...The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and... ...appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear...Remote workPolicyFor contractorsPrivate practiceWork at officeLocal area- ...Under the direction of the Senior Medical Director, the Medical Director will lead and participate... ...of comprehensive medical policies and standards of care. The Medical Director... ...Participate in MPC/MCO Grievance and Appeals Review Processes. Participate in the...Remote workPolicyFull timeTemporary workWork experience placementWork at officeLocal area
$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This...Remote workContract workWork at officeMonday to Friday- ...company is hiring a Physical Health Medical Director to work remotely in North Carolina. The Physical Health... ...reviews, concurrent reviews, appeals, and level of care determinations for... ...department processes-as defined by approved policies, desk procedures, and workflows...Remote workPolicyTemporary workWork experience placementWork at officeRelocationFlexible hoursWeekend work
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