Inpatient Medical Director: Utilization Review Expert
Humana
A leading healthcare company seeking a Medical Director to conduct clinical reviews and evaluate health claims. This role requires a physician with significant clinical experience and strong analytical skills. Responsibilities include reviewing inpatient medical records and ensuring compliance with healthcare standards. The position offers opportunities for impactful contributions to patient care without the demands of regular bedside duties. Excellent benefits and a supportive work environment are provided. #J-18808-Ljbffr
$223.8k - $313.1k
...caring community The Medical Director relies on medical background and reviews health claims. The Medical... ...the quality of inpatient care through clinical... ...those experienced in Utilization Review are encouraged... ...Role Overview Perform expert clinical review of inpatient...SuggestedBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayWeekend work- ...A health insurance startup is looking for an experienced Medical Director to oversee utilization reviews and prior authorizations. This remote position demands a strong clinical background with a doctorate in medicine and board certification. The ideal candidate will have...SuggestedRemote workFlexible hours
- ...seeking an enthusiastic and highly skilled Medical Director to join our growing team. This... ...responsible for overseeing and performing utilization reviews, prior authorizations, and making... ...Director will serve as a key clinical expert, ensuring appropriate resource...SuggestedFull timeRemote workFlexible hours
- Humana Inc. located in Austin, Texas is looking for a Medical Director to manage utilization oversight. Responsible for clinical review of services and adherence to regulatory standards, candidates must be MDs or DOs with extensive clinical experience. This role requires...Suggested
- ...Greenberg-Larraby, Inc. (GLI) is looking for an experienced Inpatient Medical Facility Coder to join its healthcare team in Temple, Texas. This on-site position involves reviewing and coding inpatient medical records, ensuring compliance with coding guidelines, and collaborating...Suggested
- TEXAS INDEPENDENCE HEALTH PLAN INC is seeking a Utilization Management Nurse to evaluate the appropriateness of services for members. This... ...experience. Responsibilities include performing authorization reviews and collaborating with healthcare teams. The position is...Remote job
- A healthcare company is seeking an experienced Inpatient Medical Facility Coder to join their team in Temple, TX. You will be responsible for reviewing and coding inpatient medical records, ensuring accurate billing and compliance with regulations. Ideal candidates will...
$223.8k - $313.1k
...help us put health first The Medical Director relies on fundamentals of... ...Guidance on following and reviewing Home Health, SNF, DME, dual... ...Intermediate to advanced skills utilizing Microsoft Office and... ...Qualifications Experience in an inpatient environment and/or related...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeMonday to Friday- Job Summary The Medical Director of Integrated Psychiatry is a senior clinical leader... ..., supervision, and case review with psychiatric providers, primary... ...emphasis on: Reducing avoidable inpatient and emergency department utilization Improving engagement, continuity...Work at officeLocal areaShift work
$95 - $96 per hour
...be a key member of the utilization management team. We... ...as the Physician match reviewer in Imaging cases, that... ...initially meet the applicable medical necessity guidelines,... ...by the subject matter expert. Discusses... ...assist the Senior Medical Director in research activities...Full timePart timeWork at officeImmediate start- The Centralized Accounting and Payroll/Personnel System is hiring a Utilities Accountant (Accountant III) located in Texas. You will perform complex accounting tasks such as processing utility invoices and ensuring compliance with state regulations. The ideal candidate...
$74k - $124k
...role will help us ensure that we successfully conduct thorough reviews of CMS programs, specific to the Affordable Care Act. The Consultant... ...a diverse and supportive workplace. Benefits include: Medical, Rx, Dental & Vision Insurance Personal and Family Sick Time &...Temporary workWork at officeFlexible hours- ...Overview Are you a Functional Area Expert II who would like to have a positive impact... ..., and sar to monitor system resource utilization and address bottlenecks. Troubleshooting... ...and resolve known and problematic issues. Reviewing and reporting on security principles, concepts...Temporary workWork experience placementRemote workMonday to FridayFlexible hours
- ...Solar Production Estimate Subject Matter Expert Location: Overland Park, KS, US Tualatin... ...reports and presentation Execute and or review solar resource and yield simulation of PV... ..., and/or financial analysis and models. Utilizes specialized knowledge to produce moderately...Work experience placementFlexible hours
- ...applicable framework requirements and technical knowledge required to review control monitoring data and address potential control... ...Understand the flow of information and how the information is utilized and use that knowledge to support the integrity of the Privacy...Work experience placement
$234k
...the state. Read more about THA here: Medical Director is a licensed Physician who provides clinical... ...patient examinations: medical history reviews, physical assessments, and diagnostic... ...participating in resource and utilization management. This may include but is not...Temporary workRelocation packageWeekend work- ...Consumer Complaints Investigator (Investigator III).The Public Utility Commission of Texas (PUCT) has an opportunity for a motivated professional... ...surrounding communities.If... Show more Permanent This is a Review Appraiser position with USACE, Southwestern Division (SWD), Ft...Permanent employmentFull timeFor contractors
$79.1k - $158.2k
...health record across services. Utilizing effective consulting skills... ...activities and workflow reviews, facilitate business process... ...Work alongside Oracle clinical experts, implementation consultants,... ...includes the following: # Medical, dental, and vision insurance...Contract workTemporary workWork experience placementLocal areaRemote workFlexible hours- A leading addiction treatment facility in Texas is seeking an experienced Compliance Manager. This role involves overseeing regulatory compliance, conducting audits, and providing staff training to ensure adherence to federal, state, and accreditation standards. Candidates...
- ...reinvention. Role Summary Advise clients on network strategy, utilization performance, and provider market challenges across Medicaid,... ...offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 40...Live inWork at officeLocal areaWork from home
- ...Overview Job Title: Financial Planning and Analysis Expert Job Type: Contract (Full-time or Part-time) Location: Remote Responsibilities... ...your field knowledge to enhance and refine AI models. Prepare, review, and optimize financial reporting under US GAAP/IFRS standards....Full timeContract workPart timeRemote work
$142.79k - $191.72k
...ICAM Subject Matter Expert Location: USA DC Washington - 1120 Vermont Ave NW (DCC060) Full Part/Time: Full time Job Req: RQ220501... ...Access Governance Assist with strategic planning, architectural reviews, modernization roadmaps, and evaluation of new identity capabilities...Full timePart timeLocal areaRemote workVisa sponsorship$160k - $230k
...Are you a seasoned networking and security expert with a passion for driving innovation and... ...through training programs and peer review processes. Drive thought leadership initiatives... ...awards in addition to a full range of medical, financial, and/or other benefits (...Work at officeLocal areaRemote workRelocation packageFlexible hours$160k - $230k
...Heart. The Opportunity Subject Matter Expert - Cloud Native Are you an expert at... ...Establish and uphold technical standards, peer review processes, and best practices across... ...awards in addition to a full range of medical, financial, and/or other benefits (including...Work at officeLocal areaRemote workRelocation package3 days per week- ...Wound & Skin Care is a full-service mobile medical group that delivers quality services and... ...This is a remote Medical Director position to oversee NP/PAs who are in the... ...management services. •Oversee providers and review documentation, providing feedback as needed...Remote workNight shiftWeekend work
$150k - $180k
...Assist with optimization, especially of graphics-related issues, utilizing profiling tools and coding best practices Develop and test code... ...through one to one discussions, coding explanations, code reviews, and documentation creation, etc. Required Skills/Abilities Strong...Full timeLocal areaWork from homeMonday to Friday- ...Software Architecture documentation, Technical Use Cases, and Code Review Packages. Meet periodically with onshore and offshore... ...quality, requirements specification and design methodologies. Utilize automated software test tools and frameworks such as test-driven...Local area3 days per week
$160k - $180k
...industry at Zeitview. You will be Zeitview's resident expert for one of our target verticals -- solar, wind, electric utilities, oil & gas, or commercial properties. You own... ...and stock options Your choice of multiple medical insurance plans, including options with an HSA...Work experience placementRemote workFlexible hours- ...Apply Microsoft frameworks and tools to facilitate structured reviews, value realization planning, and success measurement Core Consulting... ...Benefits available to eligible employees in this role include medical, dental, and vision insurance, comprehensive employee...
$8 - $65 per unit
Prolific is seeking Mental Health Professionals to train AI models. Join our Expert Network for flexible hours and competitive pay ranging from $8 to $65 per task. Responsibilities include reviewing AI responses, analyzing content, and providing feedback to improve AI...Remote jobWork from homeFlexible hours
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