Remote Medical Director, Appeals & Quality Programs
Centene Corporation
A diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal patient outcomes. The ideal candidate must be a licensed Medical Doctor or Doctor of Osteopathy, preferably with expertise in managing diverse populations. This role offers competitive pay, a comprehensive benefits package, and flexible work arrangements. #J-18808-Ljbffr
- ...Ladders seeks a Remote Medical Director - Appeals to lead medical oversight of utilization management, quality improvement, and appeals processes. The role involves reviewing complex cases, guiding medical necessity decisions, and partnering with care teams to support...Remote work
- ...The Judge Group is seeking a Medical Director – Utilization Management to provide... ...across utilization management, appeals, quality, and clinical operations. This remote, full-time role reports to... ...reviews, policy development, and program oversight, with collaboration across...Remote workFull time
- ...UnitedHealth Group, seeks a Medical Director for the Focus Claims... ...leadership over the medical review program, ensuring quality and coordination of... ...provider discussions and appeals. The role may involve policy... ...providers. You will work remotely from anywhere in the U.S....Remote work
$248.5k - $373k
...,000/yearJob Area: Medical & Clinical OperationsCompany... ...barriers to quality care. The work you... .... Work at home!The Appeals and Grievances Medical Director is responsible for... ...flexibility to work remotely * from anywhere... ...and the sharing of program resultsProvide clinical...Remote workMinimum wageFull timeWork experience placementLocal areaWork from home$248.5k - $373k
...and removing barriers to quality care. The work you do here... ...the flexibility to work remotely * from anywhere within the... ...Responsibilities: The Appeals and Grievances Medical Director is responsible for... ...evaluation, and the sharing of program results Provide clinical...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$97.3k - $227.68k
...DESCRIPTION Job Summary Leads and directs team responsible for quality management and quality performance improvement activities.... ...quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program...Remote workFull timeContract workFor subcontractorWork at officeNight shift$236.5k
...Purpose:Assist the Chief Medical Director to direct and... ...the medical management, quality improvement and credentialing... ...management programs in accordance with regulatory... ...teams, network providers, appeals team, medical and... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$174.07k - $374.92k
...and prioritize safety and quality in everything we do.... ...Virginia). This is a remote based (work at home) based... ...Responsibilities of this Medical Director role are related to Medicaid Appeals You will support the... ...or short-term incentive program in addition to the base...Remote workHourly payFull timeTemporary workLocal areaWork from home- ...subsidiary, seeks an experienced Medical Director to lead Medicare Appeals. This remote role can be based anywhere in the... ...for CVS Health's bonus and equity programs. You will direct daily work on... ..., and collaborate with Medicare Quality and Compliance to advance policy...Remote work
$215k - $408.5k
...For our client, we are seeking a Remote Medical Director, Appeals to join the team of a leader in the Hospitals... ...across utilization management, quality improvement, and appeals processing... ...improvement and utilization management programs in compliance with regulations...Remote workWork at officeVisa sponsorshipFlexible hours$174.07k - $374.92k
...client, we are seeking a Medical Director - Medicare Appeals to join the team of a leader... ...Healthcare space. This remote leadership role will oversee... ..., Utilization Management, Quality, and Compliance teams to strengthen... ...savings options Wellness programs Resources for physical,...Remote workVisa sponsorshipWeekend work$236.5k
...Purpose:\n Assist the Chief Medical Director to direct and... ...the medical management, quality improvement and credentialing... ...management programs in accordance with regulatory... ..., network providers, appeals team, medical and... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$248.5k - $373k
...Appeals And Grievances Medical DirectorAt UnitedHealthcare, we're simplifying... ...barriers to quality care. The work you do... ...flexibility to work remotely from anywhere within... ...UnitedHealthcare medical directors regarding appeals... ...and the sharing of program resultsProvide clinical...Remote workMinimum wageFull timeWork experience placementWork at officeLocal area$236.5k
...professional on our Medical Management/Health... ...the Chief Medical Director to direct and... ...medical management, quality improvement and credentialing... ...management programs in accordance with... ...providers, appeals team, medical and... ...approach to work with remote, hybrid, field or...Remote workFull timePart timeWork at officeFlexible hoursWeekend work- ...Company LLC is seeking a Board-certified physician to assist the Chief Medical Officer in directing medical management, quality improvement, credentialing, and utilization review for the Georgia-based program. The role requires active medical practice, state licensure in...Remote workWeekend work
$180 per hour
...Job Description REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS \n \n $180/hour | W-2 Contract | Monday–... ...Utilization Management and Appeals programs. This is an excellent... ...team to ensure appropriate, high-quality, and medically necessary care....Remote workContract workWork at officeMonday to Friday- Centene Corp seeks a Medical Director PRN to support the CMO in directing the physician component... ...health plan units. The position is remote in Indiana, part-time (~20 hours/week... ...is required. Will lead reviews, appeals, and quality-improvement efforts. #J-18808-LjbffrRemote workPart timeRelief
- ...CVS Health, through its Aetna Better Health Louisiana program, seeks a Medical Director to advance Medicaid quality, access and outcomes. This work‑from‑home role supports Louisiana while assisting other plans as needed, driving utilization management and care reviews....Remote workWork from home
$100k - $115k
...expensive intervention. Our programs guide members through every stage... ...without compromising care quality. We believe technology should... ...grows. This is a full time remote role, open to candidates... ...meaningful equity package ~ Full Medical, Dental, & Vision coverage...Remote workFull timeFlexible hours- UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review... ...medical directors, and help shape program outcomes.This senior role requires... ...years of clinical practice, and 2+ years in quality management.J-18808-LjbffrRemote work
$272.69k - $373.8k
...Overview: Sentara Medical Group is currently seeking a Site... ....5 FTE as the SVBGH Medical Director of Quality, Regulatory, & Safety and 0.... ...data validation for quality programs such as CMS 5 Stars, P4P, Anthem... ...that are available as remote work, Sentara Health employs...Remote workFull timeTemporary workLive inLocal areaShift work- ...CVS Health is seeking a Medical Director to support Medicaid appeals nationwide via a remote, work-at-home arrangement. The role centers on ensuring timely, medically sound responses to member and provider appeals and grievances. The candidate will provide clinical...Remote workWork from home
- ...Program Manager, Clinical Quality and Safety - Division of Cancer Medicine The University of Texas MD Anderson... .... Work Location: Hybrid (Onsite/Remote) Why Us? This position offers the opportunity... ..., and prevention. Employer-paid medical coverage starting day one for...Remote workFull timeWork experience placementLocal areaRelocation package
- Elevance Health is seeking a Medical Director to oversee medical services for national accounts... ...cost-effective care in a predominantly remote setup with required in-person training.... ...The role involves clinical leadership, program development, and collaboration with clients...Remote work
- ...seeking a physician leader for a consultant Medical Director role, remote in California. You will provide clinical oversight for utilization, quality, pharmacy, credentialing, and health... ...lead medical management, grievance and appeals oversight, and collaborate with the...Remote work
$33.71 - $60.67 per hour
...liaison for all statewide appeals, fair hearings, review... ...criteria to determine medical necessity of services... ...Coordinate with Medical Director(s) to clarify medical determinations... ...approach to work with remote, hybrid, field or... ...may be subject to program eligibility. Centene...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...Leads and directs team responsible for quality interventions activities. Responsible for... ...improvement (QI) initiatives and education programs. Ensures maintenance of programs for... ...timelines. Develops and implements Molina medical record pursuit strategies and processes,...Remote work
- ...CVS Health, a Fortune 6 company, is seeking a Medical Director to support Medicaid appeals nationwide, primarily for the Southeast Region. This remote position requires an active medical license and board certification. The role involves leading appeals processes,...Remote 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 work
- ...The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple... ...benefit interpretations. This role offers full remote work across the United States, with limited in-office requirements...Remote workWork at office
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