Remote Appeals Medical Director — Strategy & Quality
Jobleads-US
- Remote job
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 cross-functional meetings and advisory tasks to improve access, quality, and outcomes. Qualified candidates are MD or DO with an active license, board certification, and at least five years of clinical practice plus two years
#J-18808-Ljbffr Jobleads-US- ...UnitedHealth Group is seeking a Medical Director for Appeals and Grievances to lead clinical review and adjudication of complex cases across multiple health plans. The role offers full remote work from anywhere in the U.S. and requires strong clinical and leadership...Remote job
- A growing healthcare facility is seeking a Remote Medical Director to provide clinical consultation and strategic advisement. This role includes implementing initiatives to enhance healthcare quality and guiding clinical operations. Candidates should possess an MD in Psychiatry...Remote work
- ...Management Company LLC in New Hampshire seeks a Full-time Medical Director to lead medical management, quality improvement and credentialing for the health plan.... ...practice, with a flexible work model including remote/hybrid options and collaboration across clinical #J...Remote workFull timeFlexible hours
- Centene is seeking a Director of Utilization Management Hospice CoE to guide enterprise strategy, governance, and operations for hospice and palliative care across Medicaid and Marketplace populations. Based remotely in Missouri, you will lead policy application, performance...Remote job
- ...Altais is seeking a Medical Director of Utilization and Medical Management for a remote, one-month opportunity. The role reports... ...leadership team to ensure high-quality, cost-efficient care across the... ...interact with plans on benefits and appeals, guiding physician education...Remote job
$195.2k - $341.6k
...CareSource in Massachusetts is seeking a Medical Director responsible for providing training and clinical consultation. This... ...prior authorization reviews, overseeing clinical appeals, and participating in quality improvement initiatives. The ideal candidate will...Full time$248.5k - $373k
...0 - $373,000.00Job Area: Medical & Clinical OperationsCompany... ...and removing barriers to quality care. The work you do... ...the flexibility to work remotely * from anywhere within the... ...Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for...Remote workMinimum wageWork experience placementLocal areaWork from home- ...UnitedHealth Group is seeking a senior Appeals and Grievances Medical Director to lead clinical review and adjudication for UnitedHealthcare and related... ...MD/DO, board certification, and 5+ years clinical plus 2+ years in quality management. #J-18808-Ljbffr Jobleads-USRemote jobWork from home
$27 - $31 per hour
Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California assignment in Los Angeles. This is a 06+ months contract with potential for extension, and is listed as remote in the LA area. The role requires extensive appeals experience within...Remote jobHourly payContract work- ...UnitedHealth Group is hiring for a remote-friendly clinical leadership role overseeing appeals and grievances across PPO, HMO, MAPD... ...emphasizes collaboration with medical directors and network management to improve access, quality, and outcomes. The role requires...Remote job
- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication... ...plan products. This role offers remote work from anywhere in the U.S. and... ...influence benefit design and patient care quality. Responsibilities include case...Remote job
- ...UnitedHealthcare is seeking an experienced Medical Director for Appeals and Grievances, with leadership in clinical review and adjudication across PPO, HMO, MAPD, and PDP products. This remote role supports diverse health plans and requires expert regulatory responses...Remote job
- ...UnitedHealthcare is seeking a Medical Director for Appeals and Grievances to oversee clinical review and... ...across multiple health plans. This remote role requires MD/DO licensure, board... ...certification, and extensive clinical and quality management experience. You will...Remote job
$195.2k - $341.6k
...Overview Job Summary: The Medical Director is responsible for... ...physician review for clinical appeals cases Participate in the... ...suspected of fraud, abuse, and quality of care concerns Participate... ...leaders to help define market strategy Community collaborative participation...Remote jobHourly payWork at officeWeekend workAfternoon shift- ...UnitedHealthcare is seeking a clinician to review appeals and grievances across PPO, HMO, MAPD and PDP products... ...regulatory responses and collaboration with medical directors and network staff. We offer remote work from anywhere in the U.S. The successful candidate...Remote job
$236.5k
...clinical professional on our Medical Management/Health... ...Purpose Supervisory Medical Director at Centene provides... ...to ensure high-quality, cost-effective care for... ...actively participates in the appeals process, ensuring that... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hours$236.5k
...clinical professional on our Medical Management/Health... ...containment, and medical quality improvement activities.... ...Assists Chief Medical Director in planning and... ...teams, network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or office...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work- ...Medical Director, Global Medical Strategy Otsuka is a leader and innovator in the therapeutic area, with a strong portfolio of development and marketed assets. The Medical Director, Global Medical Strategy is a key leader within medical affairs and serves as the medical...Remote work
- ...focusing on high-value procedures and medical necessity reviews. The role... ...and collaboration with medical directors to improve patient outcomes. You will work remotely from anywhere in the U.S., with... ...decisions and participate in quality initiatives within a large...Remote job
- ...Biocryst Pharmaceuticals, Inc. is looking for a Director of Quality Control located in North Carolina. This role will oversee all Quality Control... ..., and providing strategic leadership. Competitive benefits and opportunities for remote work available. #J-18808-Ljbffr...Remote work
$195.2k - $341.6k
...CareSource is seeking a Medical Director in Dayton, Ohio, to oversee clinical consultations, provide training, and manage prior authorizations... ...include conducting clinical reviews, participating in quality improvement initiatives, and supporting regulatory functions....Remote job- ...Senture seeks a Medical Director to lead credentialing activities, chair the Credentialing Committee, and ensure compliance with NCQA standards... ...or policy interpretation. The position may be remote within North Carolina and involves travel to client sites as...Remote job
- ...Carolina is seeking a Physical Health Medical Director to lead medical management with an emphasis... ...-based care. The role is primarily remote with occasional on-site meetings and... ...ensure appropriate levels of care, drive quality improvement, and align with regulatory...Remote job
- ...Stryker Corporation is seeking a Medical Director of Pediatrics to lead high-quality pediatric care in the Tampa Bay area. The successful candidate will provide visionary leadership, overseeing multisite pediatric services and ensuring patient-centered care. This position...
- ...Humana Inc. is seeking a Medical Director to lead Medicaid care strategy and operations in a remote setup. The role involves evaluating moderately complex to complex clinical scenarios, reviewing medical records, and determining appropriate authorization within regulatory...Remote job
- ...Progressive Community Health Centers, Inc in Milwaukee, WI is seeking a Medical Director to lead clinical quality and oversee the medical service line. Under the direction of the Chief Medical Officer, you will provide preventive and chronic care services while guiding...
- ...CareSource in Dayton, Ohio is seeking a Medical Director responsible for supporting staff through training, clinical consultations, and case reviews for members. The ideal candidate will lead prior authorization reviews, provide education, and ensure compliance with regulatory...
- ...MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting peer discussions, and guiding policy implementation. Candidates should possess a Doctor of Medicine or...Remote job
- ...an active, unrestricted license in the United States to perform medical reviews and support medical policies for the assigned regions.... ...emphasizes analytics, communication, and strategic thinking within a remote, Monday–Friday schedule. Preferred candidates have managed...Remote jobWork at officeMonday to Friday
- Centene Corporation is seeking a Medical Director to lead utilization management, quality improvement, and medical review activities. You will partner with Chief Medical Director to shape goals, policies, and cost-effective care for a diverse member population. The role...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Appeals Medical Director — Strategy & Quality. Be the first to apply!
- medical director oncology Cypress, CA
- health manager Cypress, CA
- remote medical billing manager Cypress, CA
- public health director Cypress, CA
- healthcare supervisor Cypress, CA
- psychiatry medical director Cypress, CA
- remote medical coding supervisor Cypress, CA
- clinical manager Cypress, CA
- health economics manager Cypress, CA
- clinical data manager remote Cypress, CA


