Remote Medical Director - Outpatient Medicare Utilization
Humana
New York, NY
- Remote job
Humana seeks a Medical Director to apply clinical expertise in reviewing complex outpatient cases and making coverage determinations. You will collaborate with physicians, cross-functional teams, and care management professionals to ensure quality, compliant utilization management. The role emphasizes value-based care, population health, and ongoing professional development within a structured, remote-friendly environment. #J-18808-Ljbffr Humana
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Medical Director - Outpatient Medicare Utilization in New York, NY vacancy
- ...To support Utilization Management operations, the full-time Utilization Review Medical Director will conduct clinical reviews of Durable Medical Equipment (DME) requests remotely, ensuring compliance with Medicare and Medicaid guidelines while maintaining productivity...Remote workFull time
Virtual Vocations Inc
United States4 days ago - Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast...Remote jobFull time
- ...family, is seeking an experienced physician to join the Utilization Management team. The Medical Director for Utilization Management will support WellMed... ...determinations and suggesting program improvements. This remote-friendly role offers the chance to influence care on...Remote work
AzCEP
United States1 day ago - CareOregon, Inc. seeks a Medical Director to oversee benefit/utilization management, clinical and wellness programs for members. The role involves leadership of QA, case/disease/quality management, and collaboration with physicians to improve care and utilization outcomes...Remote jobWork from home
- CVS Health is hiring a Radiation Oncology Medical Director to oversee oncology utilization, policy implementation, and review processes in a remote, home-based role. The position supports the enterprise oncology initiatives with emphasis on prior authorization, peer-to-...Remote jobWork from home
$275k - $300k
The Oncology Institute is seeking a Medical Director for Utilization Management Oncology to provide strategic oversight and support key clinical initiatives. This remote role involves conducting medical reviews of oncology treatment plans and ensuring compliance with evidence...Remote job- SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while...Remote job
- Starling Oncology is seeking a Medical Director to provide clinical expertise in utilization management for oncology care. You will review and guide medical necessity decisions, collaborating with physicians, operations, and payers to optimize outcomes and value-based care...Remote job
- WellMed, part of the Optum family, seeks a Medical Director for Utilization Management to lead and optimize our UM program. This role focuses on medical... ...program improvements while fostering a collaborative, remote-friendly work environment across the U.S. You will drive...Remote job
- WellMed, part of the Optum family, seeks a Medical Director for Utilization Management to support WellMed Medical Management, Inc. by making UM determinations... ..., and proposing program improvements. This role offers remote work from anywhere in the U.S. and integration with Optum...Remote job
- Integra Partners seeks an experienced Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a remote UM environment. You will ensure decisions meet Medicare/Medicaid guidelines and internal policies while maintaining timely throughput and...Remote job
- Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will align clinical decisions... ..., and organizational standards in a fully remote role based in the United States. You will collaborate...Remote jobPart time
- A community-focused outpatient mental health clinic in Glen Burnie is seeking a part-time Medical Director (Psychiatrist). This role includes oversight of psychiatric services... ...offers competitive pay, flexible scheduling, and remote work options. #J-18808-Ljbffr AUGUST ROSE...Remote jobPart timeFlexible hours
- UnitedHealth Group in Minnesota seeks a Medical Director to provide physician support for... ...effective, high-quality care, advances utilization management, and communicates policies to network and non-network physicians. Remote work from anywhere in the U.S. is supported...Remote job
- The Oncology Institute is seeking a Medical Director to provide clinical expertise in assessing medical necessity, appropriateness, and efficiency of oncology care with a focus on utilization management for case reviews and clinical decision making. In this collaborative...Remote job
- Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-... ...determinations align with CMS, policies, and evidence-based criteria. Remote opportunity in New Jersey for a board-certified physician...Remote job
- Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length: 6-9 months, with potential for... ...utilization management program serving Commercial and Medicare Advantage members. The Medical Director will...Remote workHourly payContract workImmediate start
$248.5k - $373k
...family medicine physician to join our Utilization Management team. Optum is a clinician-... ...the way clinicians work and live. The Medical Director for Utilization Management will support... ...You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from homeAzCEP
United States1 day ago$150 per hour
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment... ...are made in accordance with Medicare and Medicaid guidelines, health plan... ...Conditions and Additional Expectations: Remote role requiring consistent...Remote workHourly payFull timeContract workTemporary workPart timeLocal areaIntegra Partners
Troy, MIa month ago- Centene Corporation is seeking a clinical professional to lead Medical Management/Health Services for 28 million members. The role drives utilization management, quality improvement, and medical review across a national organization with flexible work options. The candidate...Remote jobFlexible hours
- Centene Corporation seeks a physician leader to direct medical management, quality improvement and credentialing for the business unit. Lead utilization management, medical reviews, and performance-improvement initiatives to enhance cost-effectiveness and care quality....Remote jobWeekend work
- ...Center is a community-focused outpatient mental health clinic... ...psychiatric rehabilitation, and medication management. Our mission is to... ...currently seeking a Medical Director (Psychiatrist) to provide clinical... ...services. Flexible scheduling and remote options are available....Remote workHourly payContract workPart timeReliefWork at officeFlexible hours
August Rose Health Center
Glen Burnie, MDa month ago - ...Medical Director Executives thrive with us! HCA Healthcare is one of the nation's leading... ...Performs data analysis related to utilization review (UR) metrics, works with hospital... ...guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology...Remote workDaily paidWork experience placementWork from home
HCA Florida West Tampa Hospital
United States3 days ago $249.84k - $374.76k
...Job Description The Senior Medical Director is a strategic clinical and... ...by translating clinical, utilization, quality, and financial data... ...authorization requests. For Medicare line of business (LOB) only:... ...may be opportunity for remote work within all jobs posted...Remote workExcellus BCBS
New York State3 days ago$206.01k
...Position Purpose The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research emerging molecular... ...-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location...Remote workFull timeFor contractorsWork experience placementWork at officeLocal areaMonday to FridayPalmetto GBA, LLC
Kentucky2 days ago$223.8k - $313.1k
...our caring community The Medical Director relies on medical background... ...Medicine, or those experienced in Utilization Review are encouraged to... ...or inpatient review (Medicare Advantage, Managed Medicaid,... ...Travel: While this is a remote position, occasional travel...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend workHumana
Pierre, SD3 days ago$275k - $325k
...and growing, Starling Oncology is changing oncology for the better. For more information, visit Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona Oregon...Remote workWork from home$225k - $300k
100% Remote, Medical Director Job Title: Physician-CW - Medical Director-CW Estimated full... ...or WV license Strong Payer-Side Utilization Management experience Medical... ...Clinical, Direct Patient care (hospital, outpatient, or private practice) • Medical...Remote workFull timeContract workPrivate practiceFlexible hoursInterSources
Houston, TX2 days ago- ...company is hiring a Physical Health Medical Director to work remotely in North Carolina. The Physical... ...goals related to clinical quality, utilization management, and care coordination.... ...care determinations for inpatient and outpatient services Participate in internal...Remote workTemporary workWork experience placementWork at officeRelocationFlexible hoursWeekend work
Randstad
United States2 days ago $200k - $300k
...Medical Director, Medicare Clinical Policy Molecular Pathology Preferred | Additional Clinical Specialties... ...Considered Full-time, exempt | Remote Anticipated base salary: $200,00... ...and a credible connection to policy, utilization, quality, or medical review. What...Remote workFull timeFor contractorsLocal areaAscendo
Houston, TX2 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Director - Outpatient Medicare Utilization. Be the first to apply!
Related searches
- medical project manager New York, NY
- home health director New York, NY
- clinical data manager New York, NY
- clinical operations supervisor New York, NY
- health economics manager New York, NY
- clinical supervisor lmft lcsw New York, NY
- remote medical coding supervisor New York, NY
- occupational health manager New York, NY
- entry level clinical data manager New York, NY
- lead clinical data manager New York, NY