Remote Medical Director: Medical Necessity Review
$190k - $200kIntegrated Resources Inc
A healthcare management organization is seeking a Medical Director for a remote position. The role involves reviewing medical records, making decisions on service requests, and ensuring compliance with national guidelines. Candidates must have an MD or DO, 5+ years of clinical experience, and a valid medical license. This contract position offers a competitive salary range of $190,000–$200,000. Ideal for professionals with a background in inpatient care and strong communication skills. #J-18808-Ljbffr
- ...Brighton Health Plan Solutions seeks a Medical Director to perform utilization review and medical necessity determinations for BHPS-administered self-funded commercial... ...decisions that guide member care. This remote role requires board-certified physicians with UR...Remote work
- ...Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews and complex case analyses, leveraging CMS regulations, Humana policies, and... ...unrestricted medical license, and board certification. Remote work with some travel supports Humana’s mission...Remote work
$223.8k - $313.1k
...of our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director... ...and thoughtful medical necessity review. This position is well-suited... ...information. Travel: While this is a remote position, occasional travel to...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- ...of The Cigna Group, seeks a Medical Director in Otolaryngology to deliver evidence-based medical reviews supporting high-quality patient... ...professionally in a fully remote role. You’ll conduct peer-to-... ...consultations, review medical necessity, and recommend alternatives as...Remote job
- Humana is seeking a Medical Director to provide expert inpatient medical necessity reviews, leveraging national guidelines, CMS regulations, Humana policies, and clinical... ..., with typical Monday-Friday hours and a remote work setup. Occasional travel to Humana offices...Remote workMonday to Friday
$125 per hour
...Independent Consultant - Medical Director, Oncology & Specialized Clinical Review (Garden City, NY) HealthCare Partners... ...Services will generally be performed remotely and on an as‑needed basis, based... ...regarding medical necessity, appropriateness, and clinical rationale...Remote workHourly payFull timePart timeFor contractorsLocal areaFlexible hours- ...seeks an Independent Consultant - Medical Director, Oncology & Specialized Clinical Review to provide expert oncology/hematology consulting on a flexible, remote basis. The role offers hourly... ...focusing on clinical review, medical necessity, and evidence-based practice...Remote workHourly payFlexible hours
- ...Integrated Resources, Inc ( IRI ) Title: Medical Director Location: REMOTE Duration: 06+ months (Potential... ...Medical Director’s work includes reviewing all submitted medical records,... ...comprehensive, timely, and compliant medical necessity reviews for inpatient services....Remote workContract work
- ...CorroHealth is seeking a Medical Director, Concurrent Review, to evaluate hospitalizations nationwide. The role emphasizes using clinical expertise... ...admission status and provide expert recommendations. This remote position offers a predictable schedule and a path to...Remote work
- ...Clinical CM based in Oregon. The role oversees clinical reviewers in utilization review to determine medical necessity, quality, and appropriateness of care. You will... ...with stakeholders, and ongoing process improvements in a remote-friendly setting. #J-18808-LjbffrRemote work
- ...CorroHealth Inc. seeks a Medical Director, Concurrent Review to evaluate hospitalizations nationwide from a remote setting. You will review cases in real time and after discharge, advising on admission status and ensuring appropriate payments while supporting hospital...Remote workAfternoon shift
$269.5k - $425.5k
A leading healthcare organization is seeking a Medical Director to oversee Clinical Review efforts. This role involves providing expertise in DRG coding and collaborating with diverse teams to improve health outcomes. Candidates must possess an MD or DO, board certification...Remote workFull time- ...CAI is seeking a Medical Director to oversee utilization management, ensuring compliance with... ...current clinical standards. This full-time, remote role requires board-certified MD/DO... ...years of direct patient care. You will review cases, draft rationales, and...Remote workFull time
$220k - $230k
...Clinical Review Medical Director (Remote)Compensation and Benefits Salary: $220,000 – $230,000 Full benefits + 401(k) match Generous PTO Strong work-life balanceLocation: Remote | Full-TimePosition SummaryA growing healthcare organization is seeking a Clinical Review Medical...Remote work- ...seeking an Infusion Clinical Review Coordinator to support our... ...Pharmacy and work Remotely (USA) . Join us in Simplifying... ...Weekends or Holidays Affordable Medical, Dental, and Vision Insurance... ...if the service meets medical necessity of the payer Reviews and comprehends...Remote workImmediate startMonday to FridayFlexible hours
- ...AllMed is seeking a Clinical Quality Assurance Coordinator to perform quality utilization reviews and ensure medical necessity aligns with evidence-based guidelines. This 100% remote role supports Pacific Time Zone operations and may require occasional weekend coverage....Remote work
- ...Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple... ...requirements. You will review PA requests for medical necessity, assess complex cases, and guide the...Remote workShift work
- ...HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer non-qualifying cases to Physician...Remote work
- ...seeking a Psychiatrist (PRN) / Claims Reviewer in Maine. The role focuses on independent medical service appeal reviews, expert... ..., and the position is primarily remote with occasional onsite client... ..., applying standards of medical necessity, and coordinating with legal...Remote workRelief
- Cigna Health and Life Insurance Company seeks a Medical Director specializing in Otolaryngology, primarily working remotely from the United States. This role includes conducting evidence-based medical case reviews and collaborating with over 500 physician colleagues to...Remote job
- ...the Commercial Clinical Utilization Management team. The role supports clinical reviews to assess medical necessity and coordinates care across providers and members in a Hybrid Flex/Remote Flex environment rooted in North Carolina. Licensure in NC or compact multi-state...Remote workFlexible hours
- ...The Advocacy Clinical Review Coordinator investigates... ...Using clinical nursing and medical expertise, they will review medical necessity requests, determine... ...partners, including Medical Directors, Sales, Compliance, Vendors... ...may be opportunity for remote work within all jobs...Remote work
- ...Optum, part of UnitedHealth Group, seeks a Medical Director for the Focus Claims Review team. You will provide leadership over the medical review program... ...liaison with physicians and providers. You will work remotely from anywhere in the U.S. You will guide clinical...Remote work
- AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator to support 100% remote utilization review services. The role focuses on applying evidence-based guidelines to determine medical necessity and ensure accuracy and regulatory compliance across...Remote job
- ...Alnylam Pharmaceuticals in the United States is seeking an Associate Medical Safety Director to oversee daily medical review and causality assessment of ICSRs, including device safety considerations. You will contribute to safety surveillance plans and collaborate with...Remote work
- ...Commercial Clinical Utilization Management team. The role reviews medical necessity and coordinates care across members and providers to ensure... ...state license. The position supports a Hybrid-Flex work model with in-person collaboration and remote options. #J-18808-Ljbffr...Remote workFlexible hours
- Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and collaborate with physicians...Remote job
$80k - $102k
...process. Supervisor, Clinical Review Alabama Alabama, US 30+ days... ...patient outcomes. Our talented remote workforce spans the country... ...offer benefits that include: Medical, dental and vision insurance... ...reviewers to identify medical necessity/medical appropriateness as identified...Remote workContract work- Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling costs. Qualified candidates...Remote job
- ...Are you an experienced Medical Director/ Physician Reviewer with a desire to excel? If so, then Talent Software... .../ Physician Reviewer to work remotely at their company. Description:... ...criteria sets to evaluate the medical necessity and appropriateness of the...Remote workPrivate practice
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