Remote Medical Director Inpatient Utilization
Humana Inc
Humana Inc. is seeking a Medical Director to make determinations on services requested at the inpatient level, leveraging guidelines, CMS requirements, and Humana policies. The role involves review of complex clinical scenarios, collaboration with colleagues, and ongoing credentialing activities.
The position supports Humana values and may involve occasional peer discussions with external providers. After mentored training, work is performed with consistency, independence, and within compliance
#J-18808-Ljbffr$223.8k - $313.1k
...our caring community The Medical Director relies on medical background... ...to advancing the quality of inpatient care through clinical expertise... ..., or those experienced in Utilization Review are encouraged to... ...Travel: While this is a remote position, occasional travel...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- ...Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization... ...program. The role focuses on inpatient and post-acute reviews to ensure timely... ...reports to the Chief Medical Officer with remote work, a 6–9 month contract length,...Remote workContract workImmediate start
- ...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
- ...Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post-Acute) role. In... ...& Determinations Evaluate outpatient referrals, inpatient direct admissions, and home health authorization...Remote workFull timeContract workPart timeLocal areaWork from home
- Bickham Services Unlimited LLC is seeking a Medical Director, Utilization Management for a fully remote, 6-9 month contract with an immediate start. The role oversees inpatient and post-acute reviews for Commercial and Medicare Advantage members, ensuring medical necessity...Remote jobContract workImmediate start
- ...HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare... ...ensuring the clinical integrity of inpatient and post-acute care reviews,... ...regulatory compliance. Location: 100% Remote Schedule: Full-Time, Monday –...Remote workFull timeMonday to Friday
$285k - $305k
...The Strategic Medical Director Inpatient will report to the Managing Medical Director, Clinical Strategy... ...-enabled solutions. This is a remote-first role that may require travel to... ...Operations, Growth, and other teams Utilize market data, consumer research, and patient...Remote workFlexible hours$213.1k - $383.58k
...care, care for the most medically and socially complex... ...we serve. The Job The Utilization Management (UM) Physician Medical Director provides physician-level... ...requests, concurrent (inpatient) reviews, and retrospective... ...Work Mode - Mostly Remote: Employees who reside outside...Remote workFor contractorsWork at officeLocal areaRelocation- ...seeking an enthusiastic and highly skilled Medical Director to join our growing team. This pivotal... ...for overseeing and performing utilization reviews, prior authorizations, and making... ...effective peer-to-peer discussions. This is a remote position requiring a "roll up your...Remote workFull timeFlexible hours
$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This...Remote workContract workWork at officeMonday to Friday$92.29k
...visiting RNs), in VCU Medical Center (patient acquisition... ...to the Nursing Director, VCU Health at Home |... ...VCU Health at Home – Inpatient nurse Manager oversees... ...unit/program; monitors utilization of equipment and supplies... ...Experience in operations of Remote Patient Monitoring...Remote workWork experience placementWork at officeWork from homeLong distance- ...will lead the operational areas of the Utilization Management (UM) program including prospective... ..., and retrospective reviews. As a Medical Director, UM you ensure all patient care... ...Affairs. Work Arrangement ~ Fully remote; must be willing to work rotational weekend...Remote workContract workLocal areaFlexible hoursWeekend work
$240k - $250k
...Medical Director Utilization Management We are looking for physicians who have expertise in Internal Medicine including medical and surgical... ...people of different backgrounds and perspectives. This is a remote-first role that may require travel to Boston, MA for new...Remote workFlexible hours- ...Humana Inc. seeks a Medical Director to review clinical scenarios, interpret records, and authorize inpatient services in alignment with national guidelines and CMS requirements. The role involves collaboration with peers, mentors, and multiple Humana teams to ensure compliant...Remote work
$248.5k - $373k
...- $373,000.00/yearJob Area: Medical & Clinical OperationsCompany:... ...medicine physician to join our Utilization Management team. Optum is a... ...clinicians work and live.The Medical Director for Utilization Management... ...the flexibility to work remotely * from anywhere within the U....Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- 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...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
- WellMed Medical Management, Inc. is seeking a Medical Director for Utilization Management to support the UM program and optimize medical necessity determinations across plans.You'll work remotely from anywhere in the United States, require an MD/DO/MBBS with board certification...Remote job
- CAI is seeking a Medical Director to ensure utilization management is performed per current clinical standards. This full-time, remote role requires leadership in medical reviews, policy adherence, and collaboration with the CMDM team. Responsibilities include case determinations...Remote jobFull time
- ...CAI is seeking a Medical Director to oversee utilization management with a focus on clinical standards. The role is full-time and remote, offering the flexibility to impact care across the organization. The ideal candidate will hold an MD/DO, board certification, and...Remote workFull time
- Jobgether SRL is seeking a Medical Director, Utilization Management for Home Health, Acute and Post-Acute, fully remote and part-time in the United States. You will lead medical necessity reviews and mentor nursing teams while collaborating with providers to ensure evidence...Remote jobPart timeLocal area
- ...CAI is seeking a Medical Director to oversee utilization management, ensuring adherence to current clinical standards in a fully remote, full-time capacity across the United States. The role requires an MD/DO with board certification and an active state license (PA...Remote workFull time
$200k - $250k
# Medical Director, Utilization ManagementManaged Care & Clinical ProgramsOrlando, FloridaOctober 5, 2026$230,000 - $275,000 / yearFull TimeApplication... ...in the Orlando, FL area, with a combination of onsite and remote days* Monday through Friday, standard business hours (...Remote workHourly payFull timeMonday to Friday$248.5k - $373k
...** 2345838 **Job category:** Medical & Clinical Operations WellMed... ...medicine physician to join our Utilization Management team. Optum is a... ...clinicians work and live. The Medical Director for Utilization Management... ...the flexibility to work remotely * from anywhere within the U....Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$99.07k - $148.62k
...City Rochester State MN Remote NO Department Quality... ...Clinic. Benefits Highlights Medical: Multiple plan options.... ...personnel activities of the Inpatient CDI staff. Acts as a change agent... ...is present and accurate. Utilizes internal and external benchmarking...Remote workFull timeMonday to FridayFlexible hoursWeekend work$215k - $408.5k
...Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical... ...Provides medical leadership of all for utilization management, cost containment, and medical... ..., and a flexible approach to work with remote, hybrid, field or office work schedules...Remote workFull timePart timeWork at officeFlexible hoursWeekend work- ...WellSense Health Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor treatment, and support discharge planning across care teams. This fully remote, full-time role requires an active RN license,...Remote workFull time
- ...qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity and appropriate level of care. The position... ...Responsibilities include educating providers on utilization processes, sharing feedback with leadership for...Remote work
$215k - $269k
...Medical Director - Physical Health Charllotte, NC (Primarily remote, no expectation to be in the office routinely, the selected... ...related to clinical quality, utilization management, and care... ...level of care determinations for inpatient and outpatient services Participate...Remote workPermanent employmentFull timeWork at officeWeekend work- ...Medical Director Executives thrive with us! HCA Healthcare is one of the nation's leading... ...with health plan counterpart for denied inpatient cases. Acts as a liaison with... ...Performs data analysis related to utilization review (UR) metrics, works with hospital...Remote workDaily paidWork experience placementWork from home
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