Remote Medical Director, Appeals & Grievances
UnitedHealth Group
- Remote job
The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple health plans. You will apply clinical criteria, communicate decision rationales, and coordinate with medical directors and network staff to ensure accurate benefit interpretations. This role offers full remote work across the United States, with limited in-office requirements in certain markets; requires MD or DO with an active license, board #J-18808-Ljbffr UnitedHealth Group
- UnitedHealth Group is seeking a Medical Director to lead appeals and grievances review for UnitedHealthcare. This role involves adjudicating cases across PPO, ASO, HMO, MAPD, and PDP products, applying clinical criteria and regulatory requirements. We value MD/DO board-...Remote job
- ...Consulting, Inc. is seeking a Healthcare Case Manager for a 9-12 month contract located in California with remote work options. The role requires handling appeals and grievances with a strong focus on member satisfaction. The ideal candidate has 5+ years in healthcare,...Remote jobContract workMonday to Friday
$248.5k - $373k
...$248,500 - $373,000/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ...week.Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...Remote workMinimum wageFull timeWork experience placementWork at officeLocal area- Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California-based contract role in Los Angeles, with remote work options. The position targets candidates... ..., plus proven ability to review medical records and clinical documentation. #J-...Remote jobContract work
$257.05k - $340.59k
...KHS reasonably expects to pay starting compensation for the position of Medical Director, Appeals, Grievances & Disputes in the range of $257,050 – $340,591.50 annually. Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through...SuggestedShift work$174.07k - $374.92k
...health care resources. This is a remote based (work at home) based... ...the US. Responsibilities of this Medical Director role are related to Medicare Appeals: Direct daily work on part C appeals... ...Management - Medicare Complaints, Grievance & Appeals experience. Health Plan...Remote workHourly payFull timeTemporary workLocal areaWork from homeWeekend work- A prominent healthcare organization is seeking an Appeals and Grievances Medical Director to manage clinical reviews of appeals for various health plans. The role offers flexibility to work remotely. Qualified candidates should have an MD or DO, be board certified, and...Remote job
- UnitedHealth Group in Cypress, CA, is seeking an Appeals Medical Director for Radiation Oncology. This remote role involves ongoing clinical review and adjudication of appeals and grievances across multiple health plans, with the ability to work from anywhere in the U.S...Remote jobWork at office
- UnitedHealth Group in the United States is seeking an Appeals Medical Director in Radiology for a remote role. You will oversee clinical review and adjudication of appeals and grievances across plans, contributing to quality care and regulatory compliance.The role requires...Remote job
$234.63k - $336.6k
...Your Role The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of... ...based health care system in California. The Medical Director, Utilization Management - Appeals and Grievances is a key member of BSC's Clinical Appeals and Grievance...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week$236.5k
Position Purpose:Assist the Chief Medical Director to direct and coordinate the medical management... ...clinical teams, network providers, appeals team, medical and pharmacy consultants... ..., and a flexible approach to work with remote, hybrid, field or office work schedules...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract... ...experience Experience with prior authorizations and medical necessity reviews Grievance & Appeals experience...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review and adjudication of appeals and grievances across multiple health plans. You will apply clinical criteria, coordinate with medical directors, and help shape...Remote job
$123.37k - $161.93k
Remote Hi, we're Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team. Oscar is the first health insurance company built around a full stack technology... ...are eligible for benefits including: medical, dental, and vision benefits, 11 paid...Remote workFull timeWork from homeRelocationHome office$215k - $408.5k
For our client, we are seeking a Remote Medical Director, Appeals to join the team of a leader in the Hospitals & Medical Centers space. This role provides medical leadership across utilization management, quality improvement, and appeals processing in a highly regulated...Remote jobWork at officeVisa sponsorshipFlexible hours$236.5k
...clinical professional on our Medical Management/Health Services team... ...: Assist the Chief Medical Director to direct and coordinate the... ...clinical teams, network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or office work...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application. $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension...Remote workContract workWork at officeMonday to Friday$223.8k - $313.1k
...Become a part of our caring community The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director works... .../ HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome office- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
- ...Healthfirst seeks a Grievance Specialist to join the Appeals & Grievances team. This is a 100% remote, non-clinical role focused on resolving member grievances across Medicare, Medicaid, CHPlus, SHP, QHP, EP, and CompleteCare. The Specialist will independently manage...Remote work
- VNS Health is seeking a remote-friendly Clinical Education Manager to plan, manage, and evaluate training programs for staff across... ...a BSN and a Master's in Nursing, and at least five years of Grievance and Appeals experience. Travel to NYC is expected monthly. #J-18808-...Remote work
$122.9k - $188.02k
The Senior Manager, Clinical Appeals & Grievances provides strategic and operational leadership for the Clinical Appeals & Grievances function... ...offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs...Temporary workWork experience placementLocal area- ...Managing and coordinating grievance and appeals processes, the full-time Grievance & Appeals Coordinator will review incoming cases, ensure compliance... ...collaborate with internal teams while working in a hybrid remote environment. Key responsibilities Manage and coordinate...Remote workFull timeWork at office
- ...solutions to our clients world-wide. Job Title: Medical Director Location: Remote Duration: 6 Months Job Type: Temporary... ...Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and...Remote workTemporary workPrivate practice
$59 - $60 per hour
WE’RE HIRING: REMOTE REGISTERED NURSE (RN) 100% REMOTE | MONDAY-FRIDAY | $59-$60/HR We are looking for experienced Registered Nurses... ...Management experience Prior Authorization experience Grievance & Appeals experience preferred, but not required #J-18808-Ljbffr PhaxisRemote workMonday to Friday- Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation... ...outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr HumanaRemote job
- Pyramid Consulting, Inc. seeks a Healthcare Case Manager for a 9-12 month contract in Corona, CA (Remote). The role focuses on managing appeals and grievances within health plans, using strong written and verbal skills. The candidate will work standard hours with potential...Remote jobContract workWork at office
- ...full life cycle of member and provider appeals and grievance cases, the full-time Appeals and... ...ensure timely resolution while working remotely. Key responsibilities Research and analyze... .../appeals coordination Knowledge of medical terminology, benefit interpretation, and...Remote workFull timeWork at office
$227.6k
...incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and... ...appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise...Remote workFor contractorsPrivate practiceWork at officeLocal area- A staffing solutions company is seeking a Grievance & Appeals Coordinator for a fully remote position in Detroit, MI. This role involves processing appeals, grievances, and inquiries while maintaining accurate documentation and effective communication. The ideal candidate...Remote jobContract work
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