Remote Inpatient Medical Director & Utilization Review Leader
Humana Inc
- Remote job
Humana Inc. in the United States seeks a Medical Director to perform expert inpatient medical necessity reviews, applying national guidelines, CMS regulations, Humana policies and recognized clinical standards. You will analyze complex hospital cases, communicating outcomes to external providers. Join a structured team that emphasizes integrity and professional collaboration, supporting high-quality decision-making and physician partnerships while maintaining a remote-friendly work environment #J-18808-Ljbffr Humana Inc
- ...CorroHealth is seeking a Medical Director, Concurrent Review, to evaluate hospitalizations nationwide. The... ...provide expert recommendations. This remote position offers a predictable... ...and a path to expand knowledge in Utilization Review. Ideal candidates hold an MD...Remote work
- Humana is seeking a Medical Director to provide expert inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, Humana policies, and clinical... ..., with typical Monday-Friday hours and a remote work setup. Occasional travel to Humana offices...Remote workMonday to Friday
- ...Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager (URM) to obtain and review clinical and medical service authorizations, supporting high-... ...treatment teams and external partners to secure inpatient stay authorizations, provide discharge information...Remote job
$223.8k - $313.1k
...Medical Director The Medical Director relies on medical background and reviews health claims. The Medical Director work... ...the quality of inpatient care through clinical... ...those experienced in Utilization Review are... ...Travel: While this is a remote position, occasional...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- Humana Inc. in the United States seeks a Medical Director to perform expert inpatient medical record reviews and assess medical necessity based on national guidelines... ..., and recognized clinical standards.This remote, full-time role emphasizes collaboration within...Remote jobFull timeLocal area
- ...Company LLC is seeking a qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity and appropriate level of care.... ...Responsibilities include educating providers on utilization processes, sharing feedback with...Remote work
- ...the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor treatment,... ...across care teams. This fully remote, full-time role requires an... ...care management to ensure timely reviews, document outcomes, and...Remote workFull time
- ...CAI is seeking a Medical Director to ensure utilization management aligns with current clinical standards. This full-time, remote role requires board certification and active state licensure... .... Responsibilities include case reviews, appeals handling, and developing protocols...Remote workFull time
- CAI is seeking a Medical Director to oversee utilization management, ensuring adherence to current clinical standards in a fully remote, full-time capacity across the United States.The role... ...PA/NY/WV preferred). You will lead reviews, author clear rationales, and collaborate...Remote jobFull time
$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into a strategic... ...UM services, complex case reviews, appeals, and peer-to-peer... ...Scope: Experience with inpatient/outpatient UM, medical necessity... ...with a hybrid schedule (3 days remote / 2 days onsite)...Remote workFull timeWork at officeMonday to FridayShift work2 days per week- ...Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute care, ensuring medical... ...policies, and evidence-based criteria. Remote opportunity in New Jersey for a board-certified...Remote work
- ...organization focused on helping older adults stay healthy and independent. The Utilization Management Physician Medical Director will provide physician-level leadership for prior authorization, concurrent reviews, and appeals, and align with NCQA/URAC standards. Ideally local to...Remote jobLocal area
- Humana Inc. is seeking a Medical Director to review complex inpatient and post-acute cases, ensuring alignment with national guidelines and CMS requirements... ...and participating in discharge planning, quality and utilization reviews. Travel to Humana offices may be required...Remote job
- ...seeking an experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute &... ...and outpatient medical necessity reviews for Medicare Advantage populations... ...Evaluate outpatient referrals, inpatient direct admissions, and home health...Remote workFull timeContract workPart timeLocal areaWork from home
- Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length: 6-9 months, with... ...activities, with a primary focus on inpatient and post-acute care reviews. This position is responsible for ensuring...Remote workHourly payContract workImmediate start
- ...is urgently seeking a Medical Director of Utilization Management to join a leading... ...Plan. This physician leader will play a critical... ...clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity... .... Location: 100% Remote Schedule: Full-Time, Monday...Remote workFull timeMonday to Friday
$84k - $126k
...healthcare. The Virtual Utilization Review Supervisor is a key... ...and completeness of medical record documentation.... ...location. Provides inpatient and observation (if... ...hire #LI-LS1 #LI-REMOTE Join an award-winning... ...Cycle 2019-2024 Leader in Everest Group's RCM...Remote workWork at officeLocal area- ...supervision of clinical staff performing utilization reviews and specialty reviews using InterQual... ...criteria. You will mentor reviewers, ensure medical necessity decisions are accurate, and... .... This role supports a flexible remote work model with occasional on-site collaboration...Remote workFlexible hours
- AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator to support 100% remote utilization review services. The role focuses on applying evidence-based guidelines to determine medical necessity and ensure accuracy and regulatory compliance across...Remote job
- ...Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across the continuum. This... ...inpatient nursing, and 2+ years in utilization management or discharge planning, with an...Remote workWork from homeMonday to FridayWeekend work
- Harbor Oaks Hospital in New Baltimore, MI seeks a Utilization Review Manager to monitor utilization of services and optimize reimbursement while maximizing patient benefits. This non-exempt, PRN role operates weekdays with a day shift. Qualifications include current licensure...ReliefDay shiftWeekday work
- ...evidence-based care across our national network. This remote-friendly role emphasizes improving patient outcomes,... ...clinical decision-making, and collaborating with medical director teams on inpatient and claims reviews. The position requires an MD or DO, active license,...Remote job
- Cambia Health Solutions seeks an UM IP Clinical Specialist to review inpatient utilization requests, research information, and coordinate with clinicians to support efficient reviews. The role emphasizes accuracy, timeliness, and adherence to regulatory standards. Work...Remote jobWork from home
$213.1k - $383.58k
...care for the most medically and socially complex... .... The Job The Utilization Management (UM) Physician Medical Director provides physician... ...authorization, concurrent review, and appeals... ..., concurrent (inpatient) reviews, and retrospective... ...Mode - Mostly Remote: Employees who...Remote workFor contractorsWork at officeLocal areaRelocation- ...Resources, Inc ( IRI ) Title: Medical Director Location: REMOTE Duration: 06+ months (... ...Director’s work includes reviewing all submitted medical... ...medical necessity reviews for inpatient services. Maintain... ...evolving workflows, tools, and utilization management practices....Remote workContract work
$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The Jacobson... ...who enjoys clinical decision-making, medical necessity review, and appeals oversight without the responsibility of...Remote workContract workWork at officeMonday to Friday$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing... ...evidence-based guidelines. This remote role in the United States offers work...Remote jobWork from home$240k - $250k
...Medical Director Utilization Management We are looking for physicians who have expertise in Internal... ...medical appropriateness of services by reviewing clinical information and applying... ...backgrounds and perspectives. This is a remote-first role that may require travel to...Remote workFlexible hours- Mindlance is seeking a Physician Reviewer for a remote, part-time role. The position supports evaluating clinical service requests from members... ...and at least five years of clinical experience including inpatient care is required. Candidates should understand managed care...Remote jobPart time
- ...Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge, CA... ...managing daily tasks, performance reviews, and any necessary... ...collaboration with physician reviewers, medical directors, and other relevant...Remote workPermanent employmentFull timeTemporary workFlexible hours
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