Medical Director - Utilization & Policy Strategy (Remote)
MetroPlus
MetroPlus in New York seeks a Medical Director focused on health care utilization management. The position involves overseeing medical necessity reviews, conducting peer discussions, and guiding policy implementation. Candidates should possess a Doctor of Medicine or Doctor of Osteopathic Medicine degree and have significant experience in managed care settings. The ideal applicant will have a valid New York State license and demonstrate strong competencies in integrity, communication, and customer focus. #J-18808-Ljbffr
$275k
...Remote Medical Director, Hematology/Oncology (Utilization Management & Clinical Strategy) Full-Time | Remote (Post-Onboarding) | U.S. Licensed MD/DO A nationally recognized healthcare... ...with InterQual, MCG, or clinical policy guidelines Previous health plan, payer-side...Remote workPolicyFull timeRelocation packageMonday to Friday- ...operational areas of the Utilization Management (UM)... ...retrospective reviews. As a Medical Director, UM you ensure all... ...implement medical policies, procedures, and clinical... ...~ Fully remote; must be willing to work... ...of medical management strategies. Work closely with a...Remote workPolicyContract workLocal areaFlexible hoursWeekend work
$240.12k - $315.16k
...Oscar is hiring an Associate Medical Director to join the Utilization Management Team. This... ...influences departmental strategy, leading and overseeing a... ...Work Location This is a remote position, open to candidates... ...internal guidelines and policies, while using clinical acumen...Remote workPolicyImmediate startWork from home$223.8k - $313.1k
...caring community The Medical Director National OP Medicare... ...clinical guidelines, CMS policies and determinations,... ...in daily utilization management and coverage... ...and care management strategies. Work effectively in... ...Travel: While this is a remote position, occasional...Remote jobPolicyBi-weekly payFull timeTemporary workApprenticeshipWork from homeHome office- 340B Health is seeking a Medical Director in Pennsylvania to lead clinical strategy for our Medicaid line of business. This... ...role, with expertise in utilization management and medical policy. The position offers onsite/hybrid/remote work with travel within the state...Remote workPolicy
$84k - $105k
...Transformcap is seeking a Medical Director to provide clinical support for its clinical utilization management programs. This position involves completing medication utilization... ...Medicine are required. The position offers remote work with a salary range of $84,000 — $105,000...Remote workPolicy- ...Availity is seeking a Medical Director to lead the Utilization Management team for their Auth AI platform. Responsibilities... ...accuracy and validation of medical policies, and collaborating with cross-... ..., and leadership skills. This remote role offers a competitive salary,...Remote workPolicy
$130 - $140 per hour
...Remote Medical Director - Utilization Management (6-12 month contract, potential for long-term hire!) Job Summary Medix is partnering with a premier... ...care. Review escalated cases utilizing established medical policy criteria, ensuring clinical accuracy. Participate in...Remote workPolicyHourly payContract workFlexible hours- ...Now Hiring: Medical Director – Utilization Management 100% Remote | Must work PST hours Medicare Advantage | Inpatient & Post-Acute Focus We’re looking for... ...improvement initiatives Assist in developing medical policies and UM protocols Maintain accurate clinical...Remote workPolicyImmediate start
$238k - $357.5k
...people live healthier lives. The Medical Director Oncology will provide utilization review determinations and support... ...will enjoy the flexibility to work remotely from anywhere within the U.S.... ...help ensure all clinically relevant policies and processes are informed by the...Remote workPolicyFull timeLocal area$120 per hour
...message the job poster from The Judge Group Medical Director – National Utilization Management Team (One Weekend per Month) Location: Remote (U.S. only; must reside in the U.S.) Pay... ...guidelines, CMS requirements, company policies, and clinical standards Communicate determinations...Remote workPolicyOngoing contractPermanent employmentFull timeContract workImmediate start- A leading healthcare organization is seeking a Per Diem Medical Director to oversee Utilization Management. The role involves collaborating with physicians, enhancing care quality, and developing policies within a managed care environment. Candidates should have at least...Remote workPolicyHourly payDaily paid
- ...JOB DESCRIPTION Medical Director - Utilization Management (Payer Side Experience Required)- (Remote) Duration: 30 Weeks with possible extension Location:... ...case evaluations using established medical policy criteria. The Medical Director will collaborate...Remote workPolicyFull timeContract workPart timePrivate practiceMonday to FridayFlexible hours
$250k
...The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment... ...plan–specific criteria, internal policies, and regulatory requirements. This... ...Expectations: Full-time remote role requiring consistent availability...Remote workPolicyFull timeTemporary workLocal area- ...enthusiastic and highly skilled Medical Director to join our growing team.... ...overseeing and performing utilization reviews, prior authorizations... ...peer discussions. This is a remote position requiring a "roll up... ..., established medical policies, and evidence-based guidelines...Remote workPolicyFull timeFlexible hours
- ...Medical Director Utilization Management Location: Remote Preference EST or nearby Pittsburgh PA, NY, WV Duration: 6+ Months Contract Role with possible extension... ...escalated cases electronically using Medical Policy criteria sets to evaluate the medical necessity...Remote workPolicyContract workPrivate practice
$275k - $325k
...Medical Director - Utilization Management Astrana is seeking a California-licensed Medical Director -... ...updating of authorization criteria and policies based on the latest medical standards... ...Conditions This position is fully remote, with some travel to SoCal required...Remote workPolicy$248.5k - $373k
...enjoy the flexibility to work remotely from anywhere within the U.S.... ...Group's Telecommuter Policy. Primary Responsibilities Conduct... ...providers on benefit plans and medical policy Communicate and... ...be considered) Experience in utilization and clinical coverage review...Remote jobPolicyMinimum wageWork experience placementLocal area$238k - $357.5k
...Medical Director Oncology Optum is a global organization that delivers... ...Oncology will provide utilization review determinations and support... ...the flexibility to work remotely from anywhere within the U.... ...ensure all clinically relevant policies and processes are informed...Remote jobPolicyFull timeWork experience placementLocal area$186.3k
## Sr Medical Strategy DirectorApplylocations: Durham, North Carolina, United... ...**The Senior Medical Director provides strategic medical and... ...directly or indirectly.**#LI-Remote****#LI-NITINMAHAJAN**IQVIA is... ...maintains a zero tolerance policy for candidate fraud. All information...Remote workPolicyFull timePart timeImmediate startWorldwide$275k - $300k
...growing, TOI is changing oncology for the better. Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona... ..., and oversight of utilization management policies to optimize patient outcomes. Key Responsibilities...Remote workPolicyFull timeWork from home$248.5k - $373k
...medicine physician to join our Utilization Management team. Optum is a... ...work and live. The Medical Director for Utilization Management... ...enjoy the flexibility to work remotely * from anywhere within the... ...medicine guidelines, and UM policies and procedures with counsel...Remote jobPolicyMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- ...Purpose: The Medical Director, Utilization Management is responsible for assuring... ...Plan members. This fully remote role will be responsible... ...and established business strategies. Provide expedited review... ...accordance with the established policies of the Health Plan....Remote workPolicyFull timeWork at office
$89.65k - $152.4k
...Gas Utility Decarbonization Strategy Manager (Hybrid Reston, VA or US Remote) What would you do? You will be a key member of a client facing consulting team... ...and adapt to changing market, technology, and policy conditions over the coming years. The team performs...Remote workPolicyFull timeContract workWork experience placementWork at office$280k - $345k
...This position interacts with utilization management, clinical... ...health plan departments. As a Medical Director in Utilization Management, you... ...network regarding: medical policies, utilization management, use... ...love for problem solving. #LI-Remote Salary Range: $280,000 - $34...Remote workPolicyFull timeContract workInternship- ...A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making... ...ensuring compliance with national guidelines and company policies. Ideal candidates will have significant clinical experience...Remote workPolicyContract workWeekend work
- A growing healthcare facility is seeking a Remote Medical Director to provide clinical consultation and strategic advisement. This role includes... .... This is an exciting opportunity to lead impactful clinical policies and practices within a dynamic team. #J-18808-LjbffrRemote workPolicy
- ...outpatient behavioral health utilization management clinicians:... ...standards. • Collaborate with Medical Directors when clinical complexity requires... ...• Uphold all organizational policies, professional standards, and... ...Demands: • Primarily remote role with periodic travel to...Remote workPolicyWork at office
- ...Position Type: Hybrid (85% remote, 15% onsite in Burbank... ...for associated medical groups. Key Responsibilities... ...reviewers, medical directors, and other departments... ..., implementing strategies for improvement. 11.... ...alignment with company policies and influence process...Remote workPolicyPermanent employmentTemporary work
$95.74k - $206.21k
...Position Summary This is a fulltime remote teleworker opportunity in Illinois. The Manager, Utilization Management, conducts oversight... ...philosophy, programs, policies and procedures. Communicates strategic... ...of experience with electronic medical records. Ability to travel up...Remote workPolicyHourly payFull timeTemporary workLocal area
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