Remote Medical Appeals Director - Clinical Review
Health Marketing
- Remote job
Health Marketing in the United States seeks an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals and grievances for health plans and insurance products. Remote work options are available. You will perform individual case reviews, respond to regulators including DOI, DMHC, and CMS, and communicate rationales with medical directors and network staff. This role also leads process improvements and staff training while providing clinical insights. #J-18808-Ljbffr Health Marketing
$248.5k - $373k
...00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...the flexibility to work remotely * from anywhere within the... ...Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals...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 companies. The role offers work-from-home flexibility across the United States. You will perform case reviews for...Remote jobWork from home
- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication of appeals and grievances across multiple health plan products. This role offers remote work from anywhere in the U.S. and a chance to influence benefit...Remote job
- ...Medical DirectorCurative is seeking an enthusiastic... ...skilled Medical Director to join our... ...performing utilization reviews, prior... ...will serve as a key clinical expert, ensuring appropriate... .... This is a remote position requiring... ...relevant regulations and appeal processes....Remote workFull time
- Health Wealth Safe is seeking an Appeals and Grievances Medical Director to review medical appeals and grievances across... ...compliance and providing clinical input. The role collaborates with... ...comprehensive benefits and flexible remote work. #J-18808-Ljbffr Health Wealth...Remote jobFlexible hours
$236.5k
...million members as a clinical professional on our Medical Management/Health... ...activities. Performs medical review activities... ...Assists Chief Medical Director in planning and establishing... ...network providers, appeals team, medical and... ...to work with remote, hybrid, field or office...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work$195.2k - $341.6k
...Overview Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Responsibilities Provide... ...physician review for clinical appeals cases Participate in the evaluation...Remote jobHourly payWork at officeWeekend workAfternoon shift- ...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... ...regulatory responses, and communications with medical directors. Required credentials include an active...Remote work
- ...UnitedHealthcare is seeking a clinician to review appeals and grievances across PPO, HMO,... ...and collaboration with medical directors and network staff. We offer remote work from anywhere in the U.S.... ...MD/DO credentials, 5+ years’ clinical practice, and strong leadership...Remote job
$236.5k
...million members as a clinical professional on our Medical Management/Health... ...Supervisory Medical Director at Centene provides... ...Participates in utilization review studies, performance... ...participates in the appeals process, ensuring... ...to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hours- ...seeking a physician leader to conduct case reviews for appeals and grievances across multiple health... ...responses, collaboration with medical directors, and guidance on benefit interpretations... ..., and at least five years of clinical practice plus two years #J-18808-Ljbffr...Remote job
$248.5k - $373k
...0.00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...coverage and medical claims reviews. Our role is to empower... ...health care costs.The Medical Director provides physician support to... ...the flexibility to work remotely * from anywhere within the U...Remote workMinimum wageWork experience placementLocal area- ...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
- ...MedCAREERS seeks an Associate Medical Director Board Certified in Medical Oncology... ...(or Hematology/Oncology) for a remote role across the USA. You will perform chart review and utilization review for... ...active license and 5+ years of clinical work. No patient contact; start...Remote jobFull timeImmediate start
- ...experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals... ...brings a strong background in clinical review, medical necessity denials, payer appeal processes... ...commercial plans. Experience managing remote and/or offshore teams (Philippines experience...Remote work
- ...perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review... ...and medical necessity criteria, coordinate with clinical and non-clinical staff, and communicate outcomes...Remote job
$174.07k - $374.92k
...outstanding opportunity for a Medical Director. Ready to take your... ...Fortune 6 company? This is a remote Work at Home position and... ...for providing clinical expertise to promote the... ...role include transactional reviews in support of the appeal process, clinical claim review...Remote workHourly payFull timeTemporary workLocal areaWork from home- ...Barbara Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate medical necessity, level of care, and payer... ...experience, and 2+ years in Utilization Review/Appeals. Strong documentation and Epic EMR skills...Remote jobRelief
$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance with clinical policies. Ideal candidates will have strong managed care and clinical...Remote jobHourly pay- ...a nonprofit health plan serving multiple states, seeks a Medical Director - Clinical Operations for a part-time, 8-hour Friday schedule. This role... ...and business mind. Responsibilities include leading reviews, committee participation, and guiding medical policy to balance...Remote jobPart time
$386.5k
...79,500/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... .... The Medical Director, Clinical AI... ...flexibility to work remotely * from anywhere within... ...for nurses, physician reviewers, and AI enabled workflowsApply... ...from production, appeals, audits, and quality...Remote workMinimum wageFull timeWork experience placementLocal area$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible extension... ..., credentialing, and appeals for high-volume inpatient and post-acute care reviews. You’ll drive medical necessity... ...and/or MCG. Inpatient clinical background or prior...Remote work$248.5k - $373k
...- $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...of the Focus Claims Review team at Optum, the Medical Director provides leadership,... ...and provider appeals. In addition, the Medical... ...the flexibility to work remotely * from anywhere within...Remote workMinimum wageWork experience placementWork at officeLocal area$215k - $270k
...Medical Director (MD or DO) (NHC-1455120) Raleigh, North Carolina... ...Location: Primarily Remote (North Carolina... ...Medical Director provides clinical leadership and oversight... ...defensible medical review decisions while collaborating... ..., concurrent, and appeal utilization management...Remote workFull timeWork visaMonday to FridayAfternoon shift$280.84k - $393.18k
...Services, the Senior Medical Director Policy & Outcomes (Sr... ...Medical Policies and clinical leadership around member... ..., grievance and appeals, delegation oversight... ...directors, as well physician reviewers, working in the... ...schedule. (Mon & Fri - remote, Tues - Thurs onsite...Remote workTemporary workLocal area$290k - $350k
...Medical DirectorHabitat Health empowers older... ...coordinated clinical and social care in... ...terms.The Medical Director is the senior clinical... ...oversees grievances, appeals, CLIA-waived... ...improvement, chart review, and audit readiness... ...administrative, community, or remote environments,...Remote workContract workTemporary workFor contractorsWork at officeWork from homeFlexible hours$160 - $170 per hour
...Medical DirectorAs the Medical Director, you will ensure utilization management responsibilities... ...and most current clinical standards. This... ...will be Full-Time and Remote.Conduct electronic review of escalated cases against... ...of cases, review of appeals and grievances, and...Remote workFull timePrivate practiceWork at officeLocal area- ...resourcesJob SummaryThe Medical Director will serve as a clinical subject matter expert responsible... ...management, medical review and population health... ...position is eligible to work remotely, hybrid or onsite in... ...authorization, concurrent review, appeals processes, and claim...Remote workWork at officeImmediate startRelocation
$173k - $250k
...Job Summary: The Medical Director will report to the Senior... ...Management, Member Appeals & Grievances, and Medical... ...of the Office of Clinical Affairs in the areas of... ...daily medical necessity reviews, evaluation of medical... ...in You: * Full-time remote work * Competitive...Remote workFull timeWork at officeFlexible hours$79.8k - $126k
...consolidating pharmacy and medical benefit... ...Summary: The Clinical Enterprise department... ...the Lead Medical Director. This position transacts... ...authorization and appeals) and responds to... ...utilization reviews (PA) and/or medical... ...location of the job. Remote, US Salary Range $...Remote workWork at officeLocal areaFlexible hoursShift work
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