Remote Appeals Medical Director — Health Policy & Quality
Texas Health Institute
- Remote job
UnitedHealth Group in the United States is hiring 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 to collaborate across clinical and business teams. Responsibilities include case review for appeals, regulatory responses, and communications with medical directors. Required credentials include an active MD/DO license and board certification, with 5+ years of clinical practice and 2+ years #J-18808-Ljbffr Texas Health Institute
$248.5k - $373k
...00.00Job Area: Medical & Clinical OperationsCompany... ...the health care experience... ...barriers to quality care. The work... ...flexibility to work remotely * from anywhere... ...:The Appeals and Grievances Medical Director is responsible... ...criteria of medical policies.Perform Department...Remote workQualityPolicyMinimum wageWork experience placementLocal areaWork from home- ...experienced clinician to join our remote team. You will review appeals, respond to regulatory... ..., and coordinate with medical directors to interpret benefits and... ..., and a track record in quality management. Expect... ...opportunities to influence policy while maintaining high standards...Remote jobQualityPolicy
- ...re simplifying the health care experience, creating... ...barriers to quality care. The work you... ...Work at home! The Appeals and Grievances Medical Director is responsible for... ...flexibility to work remotely from anywhere within... ...criteria of medical policies Perform Department...Remote jobQualityPolicyWork from home
$236.5k
...professional on our Medical Management/Health Services team.... ..., and medical quality improvement activities... ...Chief Medical Director in planning and... ...goals and policies to improve quality... ...network providers, appeals team, medical... ...approach to work with remote, hybrid, field...Remote jobQualityPolicyFull timePart timeWork at officeFlexible hoursWeekend work- ...Manager of Clinical Appeals to lead our... ...execution, ensuring quality and compliance, and... ...clinical review, medical necessity denials,... ...necessity criteria, payer policies, NCDs/LCDs, and... ...in Nursing, Health Administration, or... ...Experience managing remote and/or offshore teams...Remote workQualityPolicy
$386.5k
.../yearJob Area: Medical & Clinical OperationsCompany... ...the health care experience... ...barriers to quality care. The work... ...Management. The Medical Director, Clinical AI... ...ensure medical policies are accurately... ...to work remotely * from anywhere... ...from production, appeals, audits, and quality...Remote workQualityPolicyMinimum wageFull timeWork experience placementLocal area$248.5k - $373k
.../yearJob Area: Medical & Clinical OperationsCompany... ...improve health outcomes by... ..., the Medical Director provides... ...for the overall quality, effectiveness... ...discussions and provider appeals. In addition,... ...of policies and procedures... ...flexibility to work remotely * from anywhere...Remote workQualityPolicyMinimum wageFull timeWork experience placementWork at officeLocal area$248.5k - $373k
.../yearJob Area: Medical & Clinical OperationsCompany... ...improve health outcomes by... ..., the Medical Director provides... ...for the overall quality, effectiveness... ...discussions and provider appeals. In addition,... ...of policies and procedures... ...flexibility to work remotely * from anywhere...Remote workQualityPolicyMinimum wageFull timeWork experience placementWork at officeLocal area$248.5k - $373k
...00.00Job Area: Medical & Clinical OperationsCompany... ...improve health outcomes by... ..., the Medical Director provides... ...for the overall quality, effectiveness... ...discussions and provider appeals. In addition,... ...of policies and procedures... ...flexibility to work remotely * from anywhere...Remote workQualityPolicyMinimum wageWork experience placementWork at officeLocal area$280.84k - $393.18k
...Reporting to the Vice President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical... ...to key activities including quality management, grievance and appeals, delegation oversight, and... ...work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho...Remote workQualityPolicyTemporary workLocal area$248.5k - $373k
...directly improve health outcomes by connecting... ...to work remotely * from anywhere within... ...Work to improve quality and promote evidence... ...Work with medical director teams focusing on... ...coverage review, member appeals clinical review,... ...'s Telecommuter Policy Compensation...Remote workQualityPolicyMinimum wageWork experience placementLocal area$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible... ...management, quality improvement, credentialing, and appeals for high-volume inpatient... ...needed. Consult on SUD policy and MCM cases when... ...function: Management and Health Care Provider...Remote workQualityPolicy- ...Medical DirectorCurative is seeking an... ...skilled Medical Director to join our... ...discussions. This is a remote position... ...established medical policies, and evidence-... ...and appeal processes.Collaborate... ...Participate in quality improvement initiatives... ...electronic health records (EHR)...Remote workQualityPolicyFull time
$190k - $200k
...a board‑certified Medical Director (Internal Medicine... ...This role is fully remote and focuses on... ...management (UM), quality review, and clinical... ...services and claims appeals. Support physician... ...Consult on SUD policy and MCM cases when... ...AmBetter or other health plan operations....Remote workQualityPolicyFull time$174.07k - $374.92k
...Medical Director MPO (Medical Policy & Operations)Aetna, a CVS Health company, has an outstanding opportunity for... ...Fortune 6 company?This is a remote work at home position... ...the delivery of high quality, constituent focused... ...in support of the appeal process, clinical claim...Remote workQualityPolicyHourly payFull timeTemporary workWork from home- ...to championing the health and well-being of... ...strategies that promote medical management,... ...satisfaction, improvement to quality outcomes while... ...may be hybrid or remote and can live in... ...management appeals, including first-... ...participation in clinical and policy team activities....Remote workQualityPolicyPrivate practiceLive in
- ...directly contribute to the health and well-being of... ...SummaryThe Medical Director will serve as a clinical... ...limited to medical policy development, quality management, and provider... ...is eligible to work remotely, hybrid or onsite in... ...concurrent review, appeals processes, and claim...Remote workQualityPolicyWork at officeImmediate startRelocation
- ...transparency, and efficiency to health plan clients across... ...costs. The Medical Director serves as a clinical... ...necessity determinations, and appeal support. The Medical... ...with applicable payer policies, contractual... ...sampling approaches, and quality assurance processes to...Remote workQualityPolicy
- ...apply for the Senior Medical Director role at Iovance Biotherapeutics... ..., manufacturing, quality assurance, regulatory,... ...’ core values, policies, procedures, and business... ...accommodation. #LI-remote Seniority level ~... ...Director (REMOTE Appeals Medical Director - Pacific...Remote workQualityPolicyFull time
- ...Medical Director, Utilization Management The Medical Director... ...comprehensive high-quality health care to UPMC Health... ...members. This fully remote role will be responsible... ...with the established policies of the Health Plan.... ...grievances, provider appeals, and potential...Remote workQualityPolicyWork at office
$195.2k - $341.6k
...Medical Director The Medical Director is responsible for supporting staff... ...review for clinical appeals cases Participate in the evaluation... ...of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participates...Remote workQualityPolicyHourly payWork at officeWeekend workAfternoon shift- ...Medical Director - RemoteARC Group has an immediate... ...position is 100% remote working eastern time... ...with Medicare policies, reviewing medical... ...review staff, appeals teams) and external... ...conferences.Strengthen the quality improvement... ...in the health insurance industry...Remote workQualityPolicyPermanent employmentFor contractorsWork experience placementLocal areaImmediate start
$221.3k - $420.5k
...Remote Medical Director - South Carolina Join to apply for the... ...our Medical Management/Health Services team.... ...medical management, quality improvement and credentialing... ...goals and policies to improve quality and... ..., network providers, appeals team, medical and pharmacy...Remote workQualityPolicyFull timeWork at officeFlexible hoursWeekend work- 100% Remote in the 28 states - North... ...from accredited medical school Industry... ..., MA, FEP, and Appeals. Would cover... ...application of a Medical Director's knowledge and... ...across the Health Care division,... ...and policy Care management... ...Credentialing) Quality model design...Remote workQualityPolicy
$286.07k - $353.38k
...Join Martin's Point Health Care - an innovative, not... ...Vice President, Medical Director, Health Plan provides... ...Plan, with a focus on quality, affordability, compliance... ...quality, pharmacy, medical policy, payment policy, and... ..., including clinical appeals and grievances, using...Remote workQualityPolicyFull timeHome office- ...Medical DirectorBecome a part of our... ...communityThe Medical Director relies on... ...background and reviews health claims. The... ..., CMS policies and determinations... ...grievance and appeals processes, and... ...teams focusing on quality management, utilization... ...Style: Fully Remote in the United...Remote workQualityPolicyTemporary workWork at officeWork from homeHome officeMonday to Friday
$290k - $350k
...Medical DirectorHabitat Health empowers older adults to experience... ....The Medical Director is the senior clinical... ...for the quality, safety, experience... ...grievances, appeals, CLIA-waived onsite... ..., community, or remote environments, depending... ....Vaccination Policy, including COVID...Remote workQualityPolicyContract workTemporary workFor contractorsWork at officeWork from homeFlexible hours$202k - $303k
...Medical Director Position This position assists... ...medical management, quality improvement and... ...establishing goals and policies to improve... ...medical necessity appeals. Participates in... ...utilization and health care quality. Reviews... ...opportunity for remote work may be...Remote workQualityPolicy- 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 an...Remote jobQuality
- The Medical Director, Clinical Payment Integrity provides... ..., reimbursement policy interpretation,... ...bridge between the health plan, providers, and... ...Management, Quality, Network Management... ...validation audits, appeals, disputes, and escalated... .... Fully Remote: This role is designated...Remote workQualityPolicyWork at office
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