Remote Corporate Medical Director — Grievances & Appeals

Jobleads-US

Remote job

Humana Inc. is seeking a Corporate Medical Director who applies medical judgment to reviews of records for appeals decisions.

You will provide clinical interpretation and independent decisions on complex cases across Medicare, Medicaid, and Commercial products. The role requires an MD or DO with an unrestricted license, ABMS board certification, 5 years of post-residency experience, and knowledge of managed care operations.

#J-18808-Ljbffr Jobleads-US

Apply

Vacancy posted 3 days ago

Similar jobs that could be interesting for youBased on the Remote Corporate Medical Director — Grievances & Appeals in Augusta, ME vacancy

Remote Corporate Medical Director: Grievances & Appeals
...Humana Inc. invites applications for a Corporate Medical Director to provide clinical interpretation and decisions on the appropriateness of services. You will oversee grievance and appeal reviews, ensure compliance with policies and regulatory requirements, and act...
Remote job
Jobleads-US
Santa Fe, NM
9 hours ago
Remote Clinical Medical Director - Grievances & Appeals Expert
...Humana Inc. is seeking a Corporate Medical Director who will review medical records, interpret clinical data, and make determinations on the appropriateness of services for appeals decisions. This remote role requires leadership across Medicare, Medicaid, and Commercial...
Remote job
Jobleads-US
Juneau, AK
3 days ago
Corporate MD Grievance & Appeals
$246.1k - $344.2k
...our caring community The Corporate Medical Director relies on medical... ...reviews of medical records for appeals decisions. The Corporate Medical... ...oversee clinical reviews of grievance and appeal cases for... ...specialists Work Style: Fully remote living in the USA....
Remote work
Full time
Temporary work
Apprenticeship
Work at office
Work from home
Home office
Monday to Friday
Weekend work
Jobleads-US
Augusta, ME
3 days ago
Remote Healthcare Grievances & Appeals Case Manager
$30 - $35 per hour
...Mid-Senior Level professional for a contract role to manage grievances and appeals. Candidates should have 6+ years in customer service with strong... ...pay range of $30.00/hr - $35.00/hr based on qualifications. Remote work is available for candidates within 100 miles of...
Remote work
Contract work
For contractors
Artech L.L.C.
Portland, OR
10 hours ago
Remote Appeals & Grievances Specialist
...Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...
Remote work
Work from home
Point32Health, Inc.
Canton, MA
20 hours ago
Manager, Clinical Appeals & Grievances
$88.7k - $149.43k
The Appeals & Grievances (A&G) Weekend Inventory Manager is responsible for managing and monitoring... ...Communicate and escalate cases to Medical Peer reviewers Maintain delegated vendor... ...such as Microsoft Word and Excel, corporate email and virtual filing systems (ie....
Full time
Temporary work
Work experience placement
Local area
Weekend work
HealthFirst
New York State
19 days ago
Associate Director, Appeals & Grievances
$123.37k - $161.93k
...'re Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team. Oscar is the first... .... Work Location: This is a remote position, open to candidates who reside... ...are eligible for benefits including: medical, dental, and vision benefits, 11 paid...
Remote work
Full time
Work from home
Home office
Oscar Health
Los Angeles, CA
16 days ago
Medical Director - Utilization Management & Appeals
$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 work
Contract work
Work at office
Monday to Friday
The Jacobson Group
United States
2 days ago
Grievance &Appeals Coordinator
...Solutions is currently looking for a Grievance & Appeals Coordinator, a W2 contract engagement... ...of our largest clients in Detroit, MI! REMOTE!! Title: Grievance & Appeals Coordinator... ...and include elements that satisfy corporate, regulatory, and accreditation timeframes...
Remote work
Contract work
Strategic Staffing Solutions
Detroit, MI
1 day ago
Business Analyst III - Appeals & Grievances - REMOTE
...Position: Business Analyst III - Appeals & Grievances Location: Los Angeles, CA, US (Remote) Duration: Permanent Job Description: The Business... .... Provide analytical support for critical corporate initiatives including business function support...
Remote work
Permanent employment
Work at office
Scout Exchange
United States
2 days ago
Remote Appeals & Grievances Specialist (RN/LPN/DH)
A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...
Remote work
Healthfirst
United States
4 days ago
Remote Lead — Clinical Appeals Coordinator
...Centene Corporation is seeking a Remote Appeals Liaison to act as the statewide liaison for appeals, fair hearings... ...PST, with an emphasis on accurate medical necessity determinations.... ...letters, coordinating with Medical Directors, and maintaining NCQA/state regulatory...
Remote work
Centene Corporation
Olympia, WA
10 hours ago
Appeals and Grievances Clinical Specialist
$83.1k - $120.36k
Position Summary: The Appeals & Grievances (A&G) unit manages... ...This is either a remote or on-site position located... ..., Prior Approval, Medical Necessity, Pre-certification... ...cases for Medical Director Review ensuring that... ...Excel, as well as corporate email and virtual filing...
Remote work
Contract work
Temporary work
Work experience placement
Local area
Healthfirst
United States
2 days ago
Remote Grievance & Appeals Specialist
...A-Line Staffing Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and appeals workflow in a regulated... ..., accurate outcomes. This hybrid role offers office and remote work, standard business hours, and benefits after 90 days with...
Remote work
Work at office
A-Line Staffing Solutions
New York, NY
1 day ago
Remote Grievances & Appeals Coordinator
...TEKsystems is urgently seeking a remote Grievances and Appeals Coordinator based in California. The role requires sitting out of San Luis Obispo... ..., and coordination with Health Services QI and Medical Director teams. It is a contract role, with a competitive hourly...
Remote work
Hourly pay
Contract work
TEKsystems
United States
4 days ago
Grievance & Appeals Coordinator
...Managing and coordinating grievance and appeals processes, the full-time Grievance & Appeals Coordinator will review incoming cases, ensure compliance... ...collaborate with internal teams while working in a hybrid remote environment. Key responsibilities Manage and coordinate...
Remote work
Full time
Work at office
Virtual Vocations Inc
United States
4 days ago
Grievance & Appeals Coordinator I
...Job Title: Grievance & Appeals Coordinator I - 210056 Address: Columbus, OH Job Description: Coordinate and manage patient grievances and appeals... ...with a Recruiter or Staffing Manager! Critical Information: Remote Shift: Standard business hours Ensure compliance with...
Remote work
Full time
Shift work
A-Line Staffing Solutions
Columbus, OH
1 day ago
Medical Director
...Job Title: Medical Director – Utilization Management Location: Remote Duration: 6+ Months Contract with possible extension If you want to know about... .... Complete initial determinations, appeals, grievances, and other reviews as assigned. Compose clear...
Remote work
Contract work
Private practice
TPI Global Solutions
United, PA
2 days ago
Remote Grievances & Appeals Coordinator
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...
Remote work
Hourly pay
Full time
Elevance Health
United States
20 hours ago
Medical Director
...About The Role The Medical Director performs utilization review and medical... ...assignment. *This is a Remote Role Primary... ...rationale that is defensible on appeal, external review, and audit.... ...input on member and provider grievances and reviews complaint resolution...
Remote work
Work at office
Local area
Flexible hours
MagnaCare
United States
4 days ago
Medical Director
...solutions to our clients world-wide. Job Title: Medical Director Location: Remote Duration: 6 Months Job Type: Temporary... ...Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and...
Remote work
Temporary work
Private practice
Tekwissen
United States
20 hours ago
Appeals and Grievance Specialist
...full life cycle of member and provider appeals and grievance cases, the full-time Appeals and... ...ensure timely resolution while working remotely. Key responsibilities Research and analyze... .../appeals coordination Knowledge of medical terminology, benefit interpretation, and...
Remote work
Full time
Work at office
Virtual Vocations Inc
United States
4 days ago
Appeals Medical Director - Remote
$248.5k - $373k
...$248,500.00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ....Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...
Remote work
Minimum wage
Work experience placement
Local area
UnitedHealth Group
Cypress, CA
4 days ago
Medical Director
$195.2k - $341.6k
...Medical Director The Medical Director is responsible for supporting staff by providing training... ...Provide physician review for clinical appeals cases Participate in the evaluation... ...of the Quality Improvement Plan and corporate level quality initiatives Collaborate...
Remote work
Hourly pay
Work at office
Weekend work
Afternoon shift
CareSource
United States
20 hours ago
Medical Director
$10 - $15 per hour
...once the position is released. Role: Medical Director Duration: 6+ Months Contract-to-Hire Location: 100% Remote Rate: $200/hr on C2C... ...initial determination of cases, review of appeals and grievances, and other reviews as assigned....
Remote work
Contract work
Private practice
Anveta
United States
1 day ago
Medical Director
$191.5k - $355.6k
...responsible for assigned aspects of medical policies and programs. Performs medical appeals reviews and interacts with the... ...experience This is a remote role Are you being referred to... ...Statement: At Health Care Service Corporation, you will be part of an...
Remote work
Work at office
Health Care Service Corporation
United States
4 days ago
Medical Director
$215k - $408.5k
...clinical professional on our Medical Management/Health... ...: Full time Medical Director for our Health Plan in... ...Hampshire Centene Corporation is a leading provider... ...teams, network providers, appeals team, medical and... ...approach to work with remote, hybrid, field or office...
Remote work
Full time
Part time
Work at office
Flexible hours
Weekend work
New Hampshire Healthy Families
Derry, NH
2 days ago
Medical Director
$227.6k
...incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and... ...appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise...
Remote work
For contractors
Private practice
Work at office
Local area
Highmark Health
United States
1 day ago
Medical Director
...Medical Director At Allstate, great things happen when our people work together to... ...clinical decision-making, including appeals, rescissions, grievance reviews, and Department of Insurance... ...culture and shared purpose. You can work remotely and will commute to a nearby office...
Remote work
Work at office
Work visa
Allstate
United States
4 days ago
Medical Director
$170 per hour
...Medical Director Req number: R8700 Employment type: Full time Worksite flexibility: Remote Who we are CAI is a global services firm with over 9,000 associates... ...determination of cases, review of appeals and grievances, and other reviews as assigned...
Remote work
Hourly pay
Full time
Apprenticeship
Private practice
Work at office
Local area
Worldwide
CAI
United States
1 day ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Corporate Medical Director — Grievances & Appeals. Be the first to apply!