Remote Medical Director - Claims & Utilization Review
$248.5k - $373kOptum
Optum is seeking a Medical Director to support Enterprise Clinical Services operations. This role focuses on clinical review processes and ensures members receive cost-effective, quality medical care. You’ll collaborate with providers and lead initiatives to advance health optimization. In this role, remote work flexibility is available within the U.S. The position offers a compensation range of $248,500 to $373,000 along with comprehensive benefits. #J-18808-Ljbffr
$248.5k - $373k
...Optum is seeking an experienced Medical Director to provide physician support, ensuring cost-effective... ...members. The role involves clinical reviews and collaboration with... ...clinical experience. Flexibility to work remotely is offered, alongside a competitive compensation...Remote workClaims$248.5k - $373k
...International in Eden Prairie, Minnesota, is seeking a Medical Director to oversee clinical reviews and ensure quality medical care for members. The ideal... ...a minimum of 5 years of clinical experience. This remote position requires strong communication skills and the...Remote workClaims- ...UnitedHealth Group is seeking a Medical Director in San Jose, California, to support Enterprise... ...successful candidate will conduct coverage reviews and engage with clinical teams to... ...clinical experience in Sleep and Pulmonology. Remote flexibility is available. Comprehensive...Remote workClaims
- ...A leading healthcare company is seeking a Medical Director to review inpatient medical claims and lead clinical decision-making without the irregular hours of bedside care. Candidates should have an MD or DO, with over 5 years of clinical experience and Board Certification...Remote workClaims
- ...healthcare company in Michigan is seeking a Medical Director to oversee clinical decisions and ensure compliance... .... This position allows for occasional remote work, with responsibilities primarily involving medical reviews and teamwork within a regulated environment....Remote workClaimsCasual work
- ...leading U.S. healthcare company is seeking a Medical Director to provide medical interpretation and... ...and Medicaid. Responsibilities include reviewing clinical scenarios and collaborating... ...delivery. This role is mostly remote but may require occasional travel to company...Remote workClaims
- A leading healthcare provider is seeking a Medical Director to review health claims and ensure compliance with clinical standards. The ideal candidate... ...salary and is based in Sacramento, CA, with standard hours and some remote work flexibility. #J-18808-Ljbffr Humana IncRemote jobClaims
$269.5k - $425.5k
...Overview Medical Director - Clinical Review / DRG - Remote. Optum is a global organization that delivers care, aided by technology, to help millions... ...success in collaboration with hospital utilization management and claims adjudication teams. Collaborate with IT partners...Remote workClaimsMinimum wageFull timeWork experience placementLocal area$248.5k - $373k
...Medical Director Optum is a global organization that delivers care,... ...clinical coverage and medical claims reviews. Our role is to empower... ...clinical knowledge in various utilization management activities with... ...enjoy the flexibility to work remotely from anywhere within the U....Remote workClaimsMinimum wageWork experience placementLocal area$223.8k - $313.1k
...of our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments... ..., or those experienced in Utilization Review are encouraged to... ...information. Travel: While this is a remote position, occasional travel...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- ...Your Role The Medical Management team ensures that Blue Shield... ...in California. The Medical Director, Utilization Management - will report to... ...and collaborate on clinical review activities, which includes... ...utilization review, and provider claims dispute reviews. In addition...ClaimsFull timeWork at office
- ...deliver clinical coverage and medical claims reviews. Our role is to empower... ...health care costs.The Medical Director provides physician support... ...knowledge in various utilization management activities with... ...enjoy the flexibility to work remotely from anywhere within the U....Remote workClaimsMinimum wageWork experience placementLocal area
- ...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...Remote workFlexible hours
$250k
...Integra Partners is seeking a full-time Utilization Review Medical Director to conduct clinical reviews of Durable Medical Equipment requests. The... ...guidelines, and maintaining high productivity standards in a remote setting. The position offers a competitive salary of $25...Remote workFull time- ...S. healthcare organization is seeking an experienced Medical Director to conduct clinical reviews and guide decision-making in inpatient care. The role... ...clinical experience, with a focus on hospital medicine and utilization review. Join a distinguished team to impact patient...Remote work
- ...Optum is seeking a Medical Director Oncology in Houston, Texas, to lead utilization review determinations and support case management teams. This role offers the opportunity to work remotely from anywhere within the U.S. and plays a vital part in improving health outcomes...Remote work
$47.06k - $70.24k
...A healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting findings, and communicating with claims examiners. Candidates must have a current RN license and at least...Remote workClaims$223.8k - $313.1k
...A leading healthcare organization is seeking a Medical Director in Jefferson City, Missouri. The role involves conducting clinical reviews of inpatient records and making utilization management determinations. Candidates should possess an MD or DO, an active medical license...Remote work$65k - $75k
...Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing medical records, documenting findings,... ...experience, and 2+ years in utilization review or claims auditing. This full-time...Remote workClaimsFull time$250k
...A national healthcare solutions provider is seeking a Utilization Review Medical Director to conduct clinical reviews of Durable Medical Equipment... ...salary of $250,000 annually and various benefits, with remote work opportunities available in Michigan and other states...Remote workFull time- ...seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule... ...Monday – Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing...Remote workClaimsFor contractorsMonday to FridayFlexible hours
$223.8k - $313.1k
...leading healthcare company is seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes collaboration and structured... ...a dedicated team focused on effective utilization management while enjoying a competitive...Remote work- A leading healthcare company in Washington, D.C. is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency...Remote job
$250k
Integra Partners seeks a Utilization Review Medical Director to oversee clinical reviews of Durable Medical Equipment (DME) in a remote full-time role. This position requires adherence to Medicare and Medicaid guidelines while ensuring clinical accuracy and productivity...Remote jobFull time$248.5k - $373k
...UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical... ...The role involves conducting clinical reviews, managing medical benefits, and... ...least 5 years of clinical experience. Remote work flexibility is offered, and compensation...Remote workClaims- A national healthcare organization is seeking a Medical Director to conduct inpatient medical necessity reviews while collaborating with healthcare providers. This... ...include performing clinical reviews, providing utilization management determinations, and ensuring...Remote jobMonday to Friday
$248.5k - $373k
...SafetyCall International is seeking a Medical Director for the Clinical & Coding... ...waste, and ensuring correct claim payments. This role requires leading operational teams, reviewing clinical claims, and... ...practices. The position offers remote work flexibility and a compensation...Remote workClaims- ...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... ...peer-to-peer discussions. This is a remote position requiring a "roll up your sleeves...Remote workFull timeFlexible hours
$250k
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support... ...Conditions and Additional Expectations Full-time remote role requiring consistent availability during standard business...Remote workFull timeTemporary workLocal area$270k
...information systems. The Medical Management team is... ...-oriented Medical Director with a strong... ...(PI) and Utilization Management (UM). This... ...deep medical record review. You will be responsible... ...data analytics, claims, and FWA... ...Additionally, we embrace a remote-first culture that...Remote workClaimsFull timeWork experience placementWork at officeFlexible hours
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