Remote Medical Director - Policy, Quality & Claims
$174.07k - $374.92k9025 CVS Shared Services Resources LLC
- Remote job
9025 CVS Shared Services Resources LLC is seeking a remote Medical Director to provide clinical expertise for high-quality, patient-focused medical care. Candidates should have a strong background in health-care delivery with experience in identifying opportunities for improvement. This role requires an M.D. or D.O. with board certification and a valid state medical license. The position offers a competitive pay range of $174,070 to $374,920 along with benefits that promote overall well-being. #J-18808-Ljbffr 9025 CVS Shared Services Resources LLC
$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible extension... ...utilization management, quality improvement, credentialing... ...controversial services and claims appeals. Support... ...needed. Consult on SUD policy and MCM cases when required...Remote workPolicyClaims- ...Physician reports and accompanying medical records to ensure that the... .... Our generous paid time off policy ensures you have time to relax... ...media stipend are provided for remote workspace. About Dane Street A... ...over 200,000 insurance claims annually for leading national...Remote workPolicyClaimsTemporary work
$120 - $145 per hour
...need for a talented Medical Director . This is a 06 months... ...located in PA,NJ and DE (Remote) . Please review the... ...serves as claims administrator, and on... ...of population health, quality management, patient safety... ...help. You can access our privacy policy here. #telRemote workPolicyClaimsContract workTemporary workLocal areaImmediate start- ...patient health. We combine quality data-driven solutions... ...to serve as Clinical Medical Director in support of CMS... ...This is a high-impact, policy-adjacent role combining... ...involving out-of-network claims Develop and... ...however we are open to remote candidates in the following...Remote workPolicyClaimsFull time
$269.5k - $425.5k
...Overview Medical Director - Clinical Review / DRG - Remote. Optum is a global organization that... ...Provide consistent high-quality DRG-based clinical reviews... ...management and claims adjudication teams. Collaborate... ...Group’s Telecommuter Policy. Compensation and Benefits...Remote workPolicyClaimsMinimum wageFull timeWork experience placementLocal area$215k - $408.5k
...professional on our Medical Management/Health... ...Full time Medical Director for our Oklahoma... ...affordable, high-quality services to Medicaid... ...establishing goals and policies to improve quality... .... Reviews claims involving complex,... ...approach to work with remote, hybrid, field or...Remote workPolicyClaimsFull timePart timeWork at officeFlexible hoursWeekend work$248.5k - $373k
...Job category: Medical & Clinical Operations... ...coverage and medical claims reviews. Our role... .... The Medical Director provides physician... ...determinations, quality improvement and cost... ...to work remotely * from anywhere within... ...proprietary coverage review policies, render coverage...Remote workPolicyClaimsMinimum wageWork experience placementLocal area$248.5k - $373k
...clinical coverage and medical claims reviews. Our role is to... ...costs. The Medical Director provides physician... ...coverage determinations, quality improvement and cost effectiveness... ...flexibility to work remotely * from anywhere within... ...coverage review policies, render coverage...Remote workPolicyClaimsMinimum wageWork experience placementLocal area$248.5k - $373k
...Medical Director Optum is a global organization that delivers... ...As part of the Focus Claims Review team at Optum,... ...for the overall quality, effectiveness and coordination... ...and implementation of policies and procedures and... ...the flexibility to work remotely from anywhere within...Remote workPolicyClaimsMinimum wageWork experience placementLocal area- ...expansive network reach that medical businesses need to get... ...with an exceptional remote workforce across the... ...Engineering, the Medical Director will lead a team of UM... ...interpretation of payer medical policy guidelines, the... ..., prior authorization, claims appeals/denials, either...Remote workPolicyClaimsHourly payWork at officeLocal area
- ...Health Institute is looking for a Medical Director to lead clinical coverage and medical claims reviews in Phoenix, Arizona.... ...multidisciplinary team and ensuring quality medical care. The ideal... ...of clinical practice experience. Remote flexibility is offered with a focus...Remote jobPolicyClaims
$281.11k
...SummaryReporting to the Chief Medical Officer, or his/... ..., the Medical Director is responsible for... ...for utilization, quality, care management... ...work a hybrid or remote schedule depending... ...resolving medical claims review, grievances... ...; develops UM policies and procedures in...Remote workPolicyClaimsContract workPart timeLocal areaRelocationRelocation package$223.8k - $313.1k
...our caring community The Medical Director uses their medical background... ...clinical guidelines, CMS policies and determinations, clinical... ...participating in teams focusing on quality management, utilization... ...Travel: While this is a remote position, occasional travel...Remote workPolicyClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome office- ...support of the CMO, the Associate Medical Director is responsible for the... ...regarding the efficiency and quality of the health care delivered... ...matters of medical policy and medical administration... ...guidelines and parameters for claims review Assist in the training...Remote workPolicyClaimsContract workWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work
- ...Medical Director The expected pay range is based on many... ...change. This is a remote position. Must reside... ...Health Plan's utilization, quality, pharmacy, and... ...in resolving medical claims review, grievances, appeals... ...direction for clinical policies, procedures, and programs...Remote workPolicyClaimsContract workFlexible hours
$223.8k - $313.1k
...caring community The Medical Director relies on medical... ...background and reviews health claims. The Medical Director... ...to advancing the quality of inpatient care through... ...regulations, Humana policies, and recognized clinical... ...While this is a remote position, occasional travel...Remote workPolicyClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$100 per hour
...local laws. Job Title Medical Director Location CP Rochester... ...hours of operation (some remote work possible).... ...skills that will enhance quality of life for individuals... ...disability insurance policy Clinical experience supporting... ...justifies each claim for service. Participates...Remote workPolicyClaimsHourly payContract workWork experience placementWork at officeLocal areaMonday to FridayFlexible hours$140 - $145 per hour
...healthcare services. The position requires a Medical Doctor (MD) or DO with extensive clinical... ...will provide strategic guidance, lead quality initiatives, and engage with stakeholders... ...outcomes. The role offers a fully remote work environment with an hourly salary between...Remote jobPolicyHourly payFull time$190k - $200k
...seeking a board‑certified Medical Director (Internal Medicine or... .... This role is fully remote and focuses on utilization management (UM), quality review, and clinical... ...controversial services and claims appeals. Support... ...needed. Consult on SUD policy and MCM cases when...Remote workPolicyClaimsFull time$248.5k - $373k
...Medical Director Oncology Optum is a global organization... ...the flexibility to work remotely from anywhere within the... ...clinically relevant policies and processes are informed... ...to close clinical quality / service gaps, and care... ....g., quality metrics, claims and health record data...Remote jobPolicyClaimsMinimum wageWork experience placementLocal area- ...looking for a Clinical Quality Assurance Coordinator to... ...This Role Rocks 100% Remote - Enjoy the flexibility... ...obtained from reputable medical journals and/or publications... ...with all company policies and procedures and client... ...workers' compensation claims. MES has been providing...Remote workPolicyClaimsLocal areaWork from homeMonday to FridayNight shiftRotating shift
$238k - $357.5k
...Medical Director Oncology Optum is a global organization... ...the flexibility to work remotely from anywhere within the... ...clinically relevant policies and processes are informed... ...to close clinical quality / service gaps, and care... ....g., quality metrics, claims and health record data...Remote jobPolicyClaimsFull timeWork experience placementLocal area$174.07k - $374.92k
...CVS Health company, offers a remote Medical Director (MPO) position. The role... ...clinical expertise to promote high‑quality, patient‑focused medical... ...emphasis on clinical and payment policy across commercial and... ...the appeal process, clinical claim review, and predetermination...Remote workPolicyClaimsHourly payFull timeTemporary workLocal area$174.07k - $374.92k
...prioritize safety and quality in everything we do.... .... This is a remote based (work from home... ...Investigators, Managers, and Directors as appropriate in... ...of control gaps in Policies, Procedures, Claims edits etc., and... ...information related to medical record review determinations...Remote workPolicyClaimsFull timeLocal areaWork from home$202k - $303k
...position assists the Chief Medical Director to direct and... ...the medical management, quality improvement and credentialing... ...goals and policies to improve quality and... ...care quality. Reviews claims involving complex, controversial... ...be opportunity for remote work within all jobs posted...Remote workPolicyClaims- ...Supervisor, Quality Assurance (Clinical) In October... ...operational results for a remote team of nurses and... ...experience and knowledge of claims auditing, supporting... ...to the development of medical review guidelines and training... ...with applicable policies and procedures. Collaborates...Remote workPolicyClaimsHourly payContract workFor subcontractorWork from homeHome officeShift work
$280.84k - $393.18k
...Senior Medical Director Policy & Outcomes Find joy in serving others with IEHP... ...to key activities including quality management, grievance and... ...experience, provider relations, and claims. Serve as a liaison with... ...work schedule. (Mon & Fri - remote, Tues - Thurs onsite in...Remote workPolicyClaimsTemporary workLocal areaFlexible hours$240k - $250k
...Medical Director Utilization Management We are looking for... ...perspectives. This is a remote-first role that may... ...care to improve the quality of patient outcomes... ...care continuumincluding policy, prior authorization,... ...data with post-service claims validation, we're creating...Remote workPolicyClaimsFlexible hours$174.07k - $374.92k
...prioritize safety and quality in everything we... ...care resources. Remote based (work from... ...Arizona and have a medical license without encumbrances... ...) In the Medical Director role you will... ...for medical policy implementation. You... ...and review of claim determinations. This...Remote workPolicyClaimsHourly payFull timeTemporary workLocal areaWork from homeNight shiftWeekend work$231.9k
Join to apply for the Remote Medical Director - California role at RemoteWorker... ...the medical management, quality improvement and credentialing... ...and establishing goals and policies to improve quality and cost... ...health care quality. Reviews claims involving complex,...Remote jobPolicyClaimsFull timeWork at officeFlexible hoursWeekend work
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