Remote Inpatient Utilization Review Medical Director
Humana Inc
San Juan, TX
- Remote job
Humana Inc is seeking a Medical Director to lead inpatient medical necessity reviews and utilization management with a focus on quality and physician collaboration. The role leverages hospital medicine, critical care, or ED experience to assess complex cases and support Humana’s care standards. This remote position requires MD or DO, board certification, and a valid medical license, with 5+ years post-residency experience. #J-18808-Ljbffr Humana Inc
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Inpatient Utilization Review Medical Director in San Juan, TX vacancy
- ...Humana Inc is seeking a Medical Director to lead inpatient medical necessity reviews and utilization management with a focus on quality and physician collaboration. The... ...and support Humana’s care standards. This remote position requires MD or DO, board certification...Remote work
Humana
United States2 days ago - ...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
CorroHealth Inc
United States4 days ago - 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
- Humana Inc. in the United States seeks a Medical Director to perform expert inpatient medical necessity reviews, applying national guidelines, CMS regulations, Humana... ...and physician partnerships while maintaining a remote-friendly work environment #J-18808-Ljbffr HumanaRemote 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 workHumana
United States4 days ago- 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
- ...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
- ...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
Well Sense Health Plan
United States2 days ago $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 weekMedix™
New York, NY6 hours ago- ...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 job
- ...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
Bickham Services Unlimited, LLC
United States5 days ago - 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
- ...experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post... ..., 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
- ...Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare... ...the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to... ...regulatory compliance. Location: 100% Remote Schedule: Full-Time, Monday -...Remote workFull timeMonday to Friday
- ...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
Comagine Health
United States5 days ago - 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
- 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
- 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... ...Advantage Utilization Management (UM) Physician Medical Director provides physician... ...authorization, concurrent review, and appeals... ...requests, concurrent (inpatient) reviews, and retrospective... ...Mode - Mostly Remote: Employees who...Remote workFor contractorsWork at officeLocal areaRelocation- ...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 jobWork from homeMonday to FridayWeekend work
$260k - $275k
Medical Director - Health Plan - Remote Salary Range: $260,000 - $275,000 per year Location: New York, NY Remote /... ...for supporting appropriate healthcare utilization through Utilization Management, medical necessity and appeal reviews, peer-to-peer discussions, and...Remote jobContract workMonday to Friday$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 FridayThe Jacobson Group
United States2 days ago$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 hoursCohere Health
United States3 days ago- ...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
$248.5k - $373k
...,000.00/yearJob Area: Medical & Clinical OperationsCompany... ...physician to join our Utilization Management team. Optum... ...and live.The Medical Director for Utilization... ...the flexibility to work remotely * from anywhere within... ...processesParticipates in case review and medical necessity...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from homeUnitedHealth Group
San Antonio, TX2 days ago- ...Humana, Inc. is seeking a Medical Director to review and authorize acute inpatient rehabilitation requests, with full-time remote work and a 40-hour week. You will ensure compliance with CMS, national guidelines, and Humana policies, collaborating across teams and participating...Remote workFull time
Humana Inc
Nashville, TN2 days ago - GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate holds...Remote job
- SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Inpatient Utilization Review Medical Director. Be the first to apply!
Related searches
- occupational health manager San Juan, TX
- clinical manager San Juan, TX
- remote medical billing manager San Juan, TX
- clinical data manager remote San Juan, TX
- clinical nutrition manager San Juan, TX
- hospital supervisor San Juan, TX
- medical director remote San Juan, TX
- director environmental health & safety San Juan, TX
- remote healthcare project manager San Juan, TX
- health economics manager San Juan, TX