Remote Appeals MD: Clinical Quality & Policy Leader
$248.5k - $373kSalem Health Hospitals & Clinics
Salem Health Hospitals & Clinics is looking for a qualified MD or DO to handle appeals and grievances for various health plans. The role allows you to work remotely from anywhere in the U.S. and will require strong telephonic and interpersonal communication skills. The ideal candidate will have over 5 years of clinical experience, a board certification, and project management capabilities. Compensation ranges from $248,500 to $373,000, along with comprehensive benefits. #J-18808-Ljbffr
$248.5k - $373k
...Association Inc is seeking an Appeals and Grievances Medical Director responsible for the clinical review of appeals and grievances... ...companies. Ideal candidates are MD or DO licensed professionals... ...clinical practice and 2 years in Quality Management. The compensation...Remote workQuality- ...healthcare facility is seeking a Remote Medical Director to provide clinical consultation and... ...initiatives to enhance healthcare quality and guiding clinical... ...should possess an MD in Psychiatry and a state... ...lead impactful clinical policies and practices within a dynamic...Remote workQualityPolicy
$248.5k - $373k
...Texas Health Institute is seeking an Appeals and Grievances Medical Director to oversee clinical review for appeals and grievances... ...Ideal candidates will have an MD or DO with board certification,... ...five years of clinical practice and quality management experience....Remote workQuality- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals... ...ensuring compliance with payer policies and clinical standards. Key... ...rate and recovery contribution Quality and clarity of appeal documentation...Remote workQualityPolicy
$340.87k - $413.05k
...us. The Asset Lead/Clinical Development Team Leader sits within Clinical... ...Development activities and Quality and Compliance... ...Degree Requirements MD (PhD or other high... ...centers. Employees in remote-by-design or lab-... ...applicable data privacy policies and regulations. If...Remote workQualityPolicyHourly payFull timeTemporary workPart timeFor contractorsSummer workLive inWork at officeLocal areaFlexible hoursShift work- Humana Inc is seeking a Senior Quality Assurance, Clinical Professional to join their remote team. This full-time position involves conducting quality audits and... .... Key responsibilities include developing policies, identifying improvement opportunities, and maintaining...Remote jobQualityPolicyFull time
$86.3k - $118.7k
Humana Inc is seeking a Senior Quality Assurance, Clinical Professional to enhance the quality of care through comprehensive audits and collaboration... ...and home health. You will be responsible for developing policies, maintaining communications with leadership, and...Remote jobQualityPolicyFull time- ...navigate the complex world of clinical trials to bring life-... ...for a Clinical Trial Leader (CTL) to join our A-team (office-based*/remote). As a CTL at Allucent,... ...budget, timelines and with quality. Responsibilities... ...*Our office-based work policy encourages a dynamic work...Remote workQualityPolicyContract workWork at officeFlexible hours2 days per week
- ...person deserves access to quality healthcare. We are... .... They will join the MD Advisor (MDA) team to help... ...to ensure adequate clinical coverage for the platform... ...current Rocket Doctor policy. Qualifications... ...Travel Position is remote in Canada. Must be able...Remote workQualityPolicyWork at office
- ...Clinical Appeals Specialist The Clinical Appeals Specialist reports to... ...within Brown University Health policies and procedures, works... ...committees, task forces and quality improvement teams as needed.... ...Patient Financial Services Remote Access Policy and Procedure....Remote workQualityPolicyFull timePart timeWork at officeShift work
- ...to its clients, ensuring high-quality, clinically sound decision‑making. The Clinical Appeal and Grievance Nurse is responsible... ...or without notice. This is a remote role. Primary Responsibilities... ...clinical criteria, and internal policies and procedures across multiple...Remote workQualityPolicyContract workWork at office
$92k - $148.35k
...Operations Job Sub Function: Clinical Trial Project Management... ...processes, programs, policies, and benefit plans. In that case... ...a Senior Clinical Trial Leader . This role can be in Warsaw... ...enjoys collaboration, values quality and compliance, and is motivated...Remote workQualityPolicyLocal areaWorldwide- ...highly organized Manager of Clinical Appeals to lead our clinical appeals... ...strategy execution, ensuring quality and compliance, and meeting... ...medical necessity criteria, payer policies, NCDs/LCDs, and applicable... ...plans. Experience managing remote and/or offshore teams (...Remote workQualityPolicy
$28.94 - $51.63 per hour
...communities and removing barriers to quality care. The work you do here... ...Growing together. The Clinical Appeals RN is responsible for... ...enjoy the flexibility to work remotely * from anywhere within the U... ...Group's Telecommuter Policy Pay is based on several factors...Remote workQualityPolicyHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- ...Serving as the work leader, monitors the... ...methods, deadlines and quality have been met;... ...formal grievances and appeals, to the supervisor... ...metrics, clinic wait times) for Telehealth... ...program policies and directives.... ...those located at remote sites of care;...Remote workQualityPolicyPermanent employmentLocal areaRelocation package
$100k - $150k
...As the MR Excellence Leader for Academics, you will... ...guided by established policies through the review of end... ...standards of acceptability (quality, volume, timeliness etc... ...Develop strong clinical relationships with top... ...collaboration and support. #LI-Remote #MA4 We will not...Remote workQualityPolicyRelocationVisa sponsorshipWork visaRelocation package$29 - $46.5 per hour
...heartland. Facility: Remote SD (Central Time)... ...subject matter expert for appeals and denials, provides... ...coordination, and quality assurance across the appeals... .... Conduct review of clinical-based denials (i.e.... ...knowledge of organization's policies and practices...Remote workQualityPolicyFull timePart timeWork from homeShift workDay shift- ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify... ...industry-leading speed, quality, and accuracy. We're reshaping... ...accordance with department quality policies and procedures, scoring and... ...to work independently in remote setting with minimum...Remote workQualityPolicyFlexible hours
$195.2k - $341.6k
...prescribing Serve as the clinical lead in developing and... ...based clinical policies and practices Participate... ...Assume key role in quality improvement initiatives... ...Collaborate with market/product leaders to help define market... ...as a medical doctor (MD) or Doctor of...Remote workQualityPolicyHourly payWork at officeWeekend workAfternoon shift$75 - $90 per unit
...here. TimelyCare is a clinically accountable virtual care... ...Worth, Texas. This is a remote position, reviewing candidates licensed in MD. Requirements for... ...standards for documentation quality and code of ethics Expectations... ...or local laws. This policy applies to all terms...Remote workQualityPolicyContract workWork at officeLocal areaFlexible hours$83.1k - $120.36k
...Appeals & Grievances Clinical Specialist The Appeals & Grievances (A&G) unit manages... .... This is either a remote or on-site position located... ...will be covered according to policy). Duties and Responsibilities... ...measures productivity and quality for each Specialist against...Remote workQualityPolicyContract workTemporary workWork experience placementLocal area- ...parties applying clinical criteria to establish... ...-party payors to appeal denied claims.... ...Nurse - Full Time Remote - Jefferson Health... ...based on medical policy guidelines of the... ...providing the highest-quality, compassionate clinical... ...'s professional leaders for 21st-century...Remote workQualityPolicyDaily paidFull timeTemporary workPart timeFlexible hoursShift work
$240k - $300k
...Director/Senior Director, Clinical Development to provide... ...and will support high-quality study execution, data... ...are looking for fully remote roles. Job Responsibilities... ...clinical studies (if MD) or may assist Medical... ...defined practices and policies that lead to obtaining...Remote workQualityPolicyLocal area3 days per week$95k - $150k
...responsible for providing clinical customer support as the... ...) products to ensure a quality customer experience.... ...office/home office and/or remote setting, as well as in... ...this position in: MD is $95,000 to $150,000.... ...Baltimore, MD . It is the policy of Philips to provide...Remote workQualityPolicyFull timeWork at officeLocal areaWork from homeHome officeWork visaRelocation packageFlexible hoursNight shift3 days per week$86.3k - $118.7k
...initiatives that optimize clinical operations and enhance... ...to ensure efficiency, quality, and sustainability in... ...analysis Collaborative leader with excellent communication... ...Travel While this is a remote position, occasional... ...Employer It is the policy of Humana not to discriminate...Remote jobQualityPolicyFull timeTemporary workWork at office- ...Clinical Appeals Reviewer (Licensed Healthcare Professional) Fully Remote-United States Job Type Full-time Description... ...statutes, regulations, rulings, and policy. Responds to and ensures... ...management's direction. Conducts quality reviews, as needed. Serves...Remote workQualityPolicyFull timeContract workPart timeFor contractorsWork at officeLocal areaNight shift
- ...care networks. The Office of Clinical Informatics within the Office... ...Clinical Informatics Director, MD/DO to help support a potential... ...enforce clinical informatics policies, standards, and best practices... ...change control and clinical safety/quality oversight. Clinical &...Remote workQualityPolicyContract workTemporary workWork at office
$248.5k - $373k
...looking for a qualified physician to handle appeals and grievances within their systems. This remote role allows you to work flexibly from... ...U.S. The successful candidate will have an MD or DO license and extensive clinical practice experience. Compensation ranges...Remote workQuality- .... Job Title: Clinical Financial Case Manager... ...provides advanced clinical appeal services with a focused... ...terms and payer policies/guidelines to determine... ...Manager in overseeing quality of clinical appeals and... ...Information: Location: Remote Location Position...Remote workQualityPolicyShift workDay shift
$238k - $357.5k
...organization is seeking an Appeals and Grievances Medical... ...to be responsible for clinical review and adjudication... ...allows for flexible remote work from anywhere in the... ...will have an MD or DO, be board-certified... ...significant clinical and Quality Management experience....Remote workQualityPolicyFlexible hours
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