Remote Medical Director: Policy & Case Review Leader
$191.5k - $355.6kHCSC
- Remote job
A leading healthcare organization is looking for a Physician to handle medical policy reviews and provider interactions. The role requires a current unrestricted physician license, board certification, and a minimum of 5 years of clinical experience. Strong analytical and communication skills are essential. This is a remote position, and the company offers a rich benefits package including 401(k), paid time off, and tuition reimbursement. Base pay ranges from $191,500 to $355,600 annually. #J-18808-Ljbffr HCSC
- ...HYBRID POSITION INVOLVES BOTH REMOTE WORK AND THE ABILITY TO... ...SUPPORT AND EDUCATION TO CASE MANAGEMENT AND PROVIDERS.... ...responsibility for providing medical direction, input into policy/ procedure development,... ...medical consultation and case review for Case Managers at all...Remote workPolicy
$248.5k - $373k
Wisconsin Psychiatric Association Inc is seeking an Appeals and Grievances Medical Director responsible for the clinical review of appeals and grievances cases for UnitedHealthcare-associated companies. Ideal candidates are MD or DO licensed professionals with at least...Remote job$248.5k - $373k
Stryker Corporation is looking for an Appeals and Grievances Medical Director to oversee clinical reviews related to appeals and grievances. The role demands a minimum of 5 years in clinical practice and substantial communication skills. Qualified candidates will have...Remote job$250k
...The Utilization Review Medical Director is responsible for conducting clinical... ...specific criteria, internal policies, and regulatory requirements... ...queue and maintain continuous case throughput in alignment with... ...Expectations: Full-time remote role requiring consistent availability...Remote workPolicyFull timeTemporary workLocal area$191.5k - $355.6k
...corporation is seeking a Physician (M.D. or D.O) to handle medical policy responsibilities and perform medical reviews while interacting with provider communities. The... ...of clinical experience. The position is 100% remote, with a competitive compensation package ranging...Remote jobPolicy$122.44k
...staff in administration of the Medical Review and Prior Authorization... ...including the integration of policy and education, that optimizes... ...Location: This is a remote position. Typical work hours... ...program management, utilization/case management, or medical review...Remote workPolicyContract workFor contractorsWork experience placementWork at officeLocal areaMonday to Friday- ...Medical Director Opportunity At Curative Curative is building... ...utilization reviews, prior authorizations,... ...discussions. This is a remote position requiring a "... ..., established medical policies, and evidence-based guidelines... ...a high volume of cases effectively in a remote...Remote workPolicyFull timeFlexible hours
$248.5k - $373k
...Medical Director Optum is a global organization that delivers care, aided... ...coverage and medical claims reviews. Our role is to empower... ...enjoy the flexibility to work remotely from anywhere within the U.S... ...proprietary coverage review policies, render coverage determinations...Remote jobPolicyMinimum wageWork experience placementLocal area$223.8k - $313.1k
...our caring community The Medical Director relies on medical background and reviews health claims. The... ...physicians who excel in case analysis, structured decision... ...regulations, Humana policies, and recognized... ...Travel: While this is a remote position, occasional travel...Remote workPolicyBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$34.16 - $40.14 per hour
...Lead Case Manager Sheboygan County - Health & Human Services... ...responds with trauma informed policies and practices, and we are... ...service needs by collecting and reviewing relevant information, completing... ...Hybrid work model, including remote work options, may be...Remote workPolicyWork at office- ...Resources, Inc ( IRI ) Title: Medical Director Location: REMOTE Duration: 06+ months (... ...basis to ensure cases are decisioned in a timely... ...Director’s work includes reviewing all submitted medical records... ...CMS requirements, Company policies, clinical standards, and (...Remote workPolicyContract work
$248.5k - $373k
Crains Cleveland is hiring a Medical Director in Phoenix, Arizona. This role focuses on clinical reviews and determining coverage for health services. Applicants must possess an M.D. or D.O., board certification in Otolaryngology, and 5+ years of clinical experience. The...Remote jobPolicy- Texas Health Institute is looking for a Medical Director to lead clinical coverage and medical claims reviews in Phoenix, Arizona. This position focuses on improving... ...least 5 years of clinical practice experience. Remote flexibility is offered with a focus on PST time...Remote jobPolicy
- Overview Medical Review Institute of America (MRIoA) is a nationally... ...Advisor (UM Medical Director) - Full‑time, remote (United States) Role Summary... ...with benefit plans, medical policies, and clinical guidelines.... ...issues, pending malpractice cases or legal issues. Possess...Remote workPolicyFull timeFlexible hoursShift workWeekend work
$40k - $48.3k
...emotional disorders. Our Case Managers are invaluable... ...development, and medication support and management.... ...opportunities for some remote flexibility upon the successful... ...in accordance with CNS policy Develops and... ...further information, please review the Know Your Rights notice...Remote workPolicyTemporary workWork at office$184.11k - $396.55k
...time. *** This is a fully remote, full-time position requiring... ...direction of the Executive Medical Director for Duals, the Lead Senior Medical... ...management programs and policies that improve quality, cost,... ...resistant illnesses through peer review and educational...Remote workPolicyHourly payFull timeTemporary workLocal areaMonday to Friday- ...is seeking a Clinical Review Coordinator to support... ...Infusion Pharmacy and work Remotely (USA) . Join us in... ...Holidays ~ Affordable Medical, Dental, and Vision... ...review on complex, patient cases to ensure that approval... ...payer medical policy criteria Request additional...Remote jobPolicyImmediate startMonday to FridayFlexible hours
- ...to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Assists non-clinical staff in performance of administrative reviews. Performing comprehensive provider and member appeals, denial interpretation...Remote workPolicyContract workCasual workWork at office
- ...Position Type: Hybrid (85% remote, 15% onsite in Burbank... ...for associated medical groups. Key Responsibilities... ...tasks, performance reviews, and disciplinary... ...physician reviewers, medical directors, and other departments... ...with company policies and influence process...Remote workPolicyPermanent employmentTemporary work
- ...Health Incorporated is searching for a Clinical Review Support Specialist in the United States. This remote position involves supporting medical necessity reviews, making outreach calls, and collaborating on clinical policies. The ideal candidate will hold a Physical...Remote jobPolicyWork from home
- ...Medical Review Manager At Commence, we're the start of... ...with Medicare coverage policy across the entire review... ...Contractor Medical Director (CMD) on complex clinical... ..., escalated cases, physician-level reviews... ...however we are open to remote candidates in the following...Remote workPolicyContract workFor contractorsWork at officeLocal area
- Commence, LLC is seeking a Clinical Review Coordinator to conduct mandatory case reviews and quality assurance activities. This remote position requires residence in the Las Vegas... ...review process while interpreting coverage policies. Ideal candidates will have a nursing...Remote jobPolicy
$77.96k - $120.37k
...The Case Management Supervisor is responsible for... ...management. This is a remote position. ESSENTIAL... ...daily, weekly, monthly reviews of various reports, invoices... ...manager is an RN for medical case management... ...knowledge of applicable laws, policies, and procedures in...Remote workPolicyMinimum wageFull timeWork at officeLocal areaFlexible hoursNight shift- ...Case Manager - Utilization Review Specialist - Remote The Utilization Review Specialist assumes... ...company reimbursement policies: Analyzes insurance, governmental... ...Compares inpatient medical records to established... ...advisors and medical directors for those requiring...Remote workPolicy
$170 - $175 per hour
CAI seeks a motivated Medical Director to oversee utilization management and ensure compliance with... ...clinical standards. This Full-Time, Remote position requires a Medical Doctor (MD)... ...and be proficient in critical thinking, case management, and communication. Compensation...Remote jobPolicyHourly payFull time$170 - $175 per hour
CAI is seeking a Medical Director to lead utilization management responsibilities at the highest clinical standards. This position is a full-time, remote role ideal for candidates with clinical expertise and decision-making skills. The ideal candidate will ensure compliance...Remote jobPolicyHourly payFull time$340.87k - $413.05k
...Development Team Leader sits within Clinical... ...e.g. Protocol Review Committee, support... ...Development, Regulatory, Medical, Commercial and... .... Employees in remote-by-design or lab-based... ...data privacy policies and regulations.... ...01919 : Executive Director, Clinical Development...Remote workPolicyHourly payFull timeTemporary workPart timeFor contractorsSummer workLive inWork at officeLocal areaFlexible hoursShift work$95k - $115k
...Supervisor / RN, Hospice Remote/Virtual Position... ...Nurse/RN Team Director You Can Be If... ...health, general medical surgery, oncology,... ...implementation, and review of the... ...documentation per related policies and protocols Pariticpates... ...in reinforcing Case Management skills,...Remote workPolicyFull timeWork at officeMonday to FridayFlexible hours$83.2k
...Clinical Review Coordinator At Commence, we're the... ...conducts all mandatory case review and quality assurance... ...process. The role is remote work, but you must... ...applies coverage and payment policies, standards of care, and... ..., providers, and other medical personnel. Protects...Remote workPolicyContract workFor contractorsWork at officeShift work- ...as an industry leader in serving dual... ...Strategies, tactics, policies and programs... ...Mission Our Case Managers use a... .../data review, conducts comprehensive... ...health or medical crisis and refers... ...supervisors, Medical Directors and/or other... ...Remote Work Expectations...Remote workPolicyHourly payFull timeTemporary workLocal areaShift work
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