Remote Utilization Management Medical Director
SCAN
- 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 collaborating with RN reviewers and UM leadership. The role requires an active MD/DO license and board certification, 5+ years of clinical practice, and 2–3 years in utilization management. #J-18808-Ljbffr SCAN
- ...Job Description\n Utilization Management Medical Director Oncology\n\n\n \n \n Work Location: REMOTE (work from home)\n \n \n The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with...Remote workWork from home
- ...Support utilization management processes and review authorizations for medical necessity. Perform peer-to-peer discussions with providers and mentor UM nurses.... ...-driven health insurance focused on seniors. Remote-first, mission-driven, and collaborative team....Remote work
$224k - $364k
~ Locations United States FL, United States (Remote) Job Description The Medical Director will work closely with the team to perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals...Remote workTemporary workPart timeWork experience placementInternshipSeasonal work- ...HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage...Remote work
$240k
...983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory... ...and training opportunities An award-winning remote work environment Position Summary Our Medical Director, also known as a Physician Advisor, is...Remote workFull timeTemporary workWork at officeWork from homeShift workRotating shiftWeekend work- ...Clover Health is seeking a Lead Medical Director, Utilization Management, to guide medical necessity decisions for outpatient referrals and inpatient... ...committees, and drive quality improvements, all within a remote-first framework supporting US operations. #J-18808-LjbffrRemote work
$332.3k - $377.4k
...Idaho, Nevada and Colorado, is seeking an experienced Medical Director with expertise in Utilization Management (UM), Care Management (CM) and Health Plan... ...Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work...Remote workHourly payLocal areaRelocation package- ...Centene Corporation seeks a Psychiatrist to serve as Behavioral Health Medical Director in a fully remote capacity across the United States. You will guide medical management, utilization, quality improvement, and credentialing, collaborating with multidisciplinary teams...Remote work
- ...Lead UM Medical Directors in making timely, evidence-based medical necessity decisions. Evaluate outpatient... ...appropriateness. Key Responsibilities: Manage a team, review complex cases, and chair the Utilization Management Committee. Partner with clinical...Remote workFlexible hours
$320k - $340k
...listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Medical Director, Utilization Management based in the United States.... ...quality, access, and outcomes. This remote-first role combines hands-on clinical judgment...Remote workFull timeWork at officeFlexible hours$320k - $340k
...those who need it most. The Utilization Management team supports access to... ...through timely, evidence-based medical necessity decisions and... ...policies. The Lead Medical Director, Utilization Management, will... ...Additionally, we embrace a remote-first culture that supports...Remote workFull timeWork experience placementWork at officeLocal areaFlexible hours- GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate holds...Remote job
- ...Medical Review Institute of America is seeking a Medical Director (Physician Advisor) to lead clinical utilization management, peer review activities, and clinical quality management. This remote role reports to MRIoA leadership and offers a comprehensive compensation...Remote work
- ...Centene Corp. seeks a Medical Director (PRN) to assist the CMO in directing physician utilization management for the health plan units. The role is roughly 20 hours per week with Thursdays and Fridays as the highest priority. Board-certified MD/DO with Indiana license...Remote workPart timeRelief
- ...VetJobs seeks a Medical Director (BH, UM) based remotely with Hawaii licensure to lead clinical operations for... ...of an interdisciplinary care management team across inpatient, partial hospitalization... ...include developing utilization management strategies, ensuring medically...Remote work
- Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length: 6-9 months, with potential for extension Schedule: Standard business hours; schedule to be determined with the client Start Date: Immediate...Remote workHourly payContract workImmediate start
$248.5k - $373k
...2345838 **Job category:** Medical & Clinical Operations WellMed... ...physician to join our Utilization Management team. Optum is a clinician-... ...work and live. The Medical Director for Utilization Management... ...enjoy the flexibility to work remotely * from anywhere within the...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$238k - $357.5k
...currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is... ...support staff to manage inpatient care utilization at a hospital, market, regional or... ...’ll enjoy the flexibility to work remotely * from within the State of Missouri...Remote jobMinimum wageFor contractorsWork experience placementLocal area- CVS Health is seeking a Medical Director to lead medical management for Medicaid populations with a national scope, primarily supporting Aetna Better Health of Louisiana. In this remote role, you will oversee utilization management, prior authorizations, and peer-to-peer...Remote job
- Magellan Health is seeking a Medical Director (BH, UM) for a remote position servicing Hawaii. The role requires Hawaii licensure and supports... ...involves physician oversight of an interdisciplinary team, utilization management, quality improvement, and collaboration with...Remote jobFull timePart time
$213.1k - $308.3k
...primary care, care for the most medically and socially complex populations,... ...communities we serve. The Job The Utilization Management (UM) Physician Medical Director provides physician-level clinical... ...,301 per year Work Mode - Mostly Remote: Employees who reside outside the...Remote workFor contractorsWork at officeLocal areaRelocation- ...Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute... ...align with CMS, policies, and evidence-based criteria. Remote opportunity in New Jersey for a board-certified...Remote work
$75.3k - $135.4k
...Supervises the behavioral health (BH) utilization review clinicians to ensure... ...activities of BH utilization management team. Key Details: Are you... ...know? Centene is seeking a remote Supervisor, Behavioral Health... .... Understanding of medical necessity criteria for a broad...Remote workFull timePart timeWork at officeFlexible hours- ...A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands a blend of clinical experience, leadership, and the ability to guide a team while ensuring compliance...Remote workContract workWeekend work
- ...Alliance Health in Morrisville, NC, is seeking a Director of Utilization Management for Physical Health. This full-time remote role requires travel to the Morrisville home office for occasional onsite meetings. Lead a multidisciplinary UM team to ensure appropriate...Remote workFull timeHome office
- ...CareStar, Inc. in Ohio is seeking a Clinical Services Utilization Supervisor to oversee Hamilton County and surrounding areas. You will... ...coordinate services with Medicaid and state programs. This remote with field visits role offers flexibility, competitive salary...Remote work
- ...Primary Work Location : Remote (Oregon Headquarters). This position... ...(Salaried) Division: Utilization Management Physical Strength: Light (L) Reports To: Nursing Director - RN Work Location Type:... ...Collaborates with the YCCO Chief Medical Officer (CMO) and/or...Remote workContract workFor contractorsCasual workWork at officeLocal areaFlexible hours
- ...Centene Corp. is seeking a remote Supervisor of Behavioral Health Utilization Management to lead a PIC ABA team of certified BCBAs. The role involves guiding clinicians, ensuring compliant utilization review, and collaborating with providers and health plan partners...Remote work
- ...Highmark Health is seeking a full-time RN Case Manager for a remote role requiring weekend availability and three weekdays. You will implement utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaching and case management...Remote workFull timeWeekend workWeekday work
- ...Highmark Health is seeking a full-time RN Care Manager for a remote role requiring weekend availability and three weekdays. The role focuses on utilization management, applying criteria for appropriate healthcare services, and identifying opportunities for referral to...Remote workFull timeWeekend workWeekday work
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