Remote Medical Director, Claims & Utilization
$279.5kTexas Health Institute
Texas Health Institute is seeking a Medical Director to oversee clinical review processes and ensure cost-effective care for members. This remote position requires an M.D. or D.O. with active licenses and board certification in Internal Medicine. The role demands strong skills in Evidence Based Medicine, utilization review experience, and a proven ability to lead multidisciplinary teams. Competitive salary is offered, ranging from $279,500 to $440,500 annually, accompanied by a comprehensive benefits package covering health, retirement, and employee incentives. #J-18808-Ljbffr
- ...Stryker Corporation is seeking a Medical Director to provide essential... ...clinical coverage and medical claims reviews. This role involves... ...members while engaging in various utilization management activities.... ...years of clinical experience. Remote working options are available...Remote workClaims
$238k - $357.5k
...people live healthier lives. The Medical Director Oncology will provide utilization review determinations and support... ...will enjoy the flexibility to work remotely from anywhere within the U.S.... ...other data (e.g., quality metrics, claims and health record data, utilization...Remote workClaimsFull timeLocal area$248.5k - $373k
...Medical Director Oncology Optum is a global organization that delivers... ...Director Oncology will provide utilization review determinations and... ...enjoy the flexibility to work remotely from anywhere within the U.S... ...(e.g., quality metrics, claims and health record data, utilization...Remote jobClaimsMinimum wageWork experience placementLocal area$279.5k
...Stryker Corporation is looking for a Medical Director who will provide support to Enterprise Clinical Services operations. The role emphasizes... ...from $279,500 to $440,500 annually with flexibility to work remotely. Candidates must hold an M.D. or D.O. and possess a current...Remote workClaims$279.5k
...UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services. This role involves conducting... ...Based Medicine. This position offers the flexibility to work remotely from anywhere within the U.S. Compensation ranges from $27...Remote workClaims- ...Crains Cleveland is seeking a Medical Director to support clinical operations remotely within the U.S. This role focuses on clinical coverage and medical claims reviews. Responsibilities include conducting coverage reviews and collaborating with providers for accurate...Remote workClaims
- A leading healthcare provider is seeking a Medical Director to review health claims and ensure compliance with clinical standards. The ideal candidate... ...salary and is based in Sacramento, CA, with standard hours and some remote work flexibility. #J-18808-Ljbffr Humana IncRemote jobClaims
- A leading healthcare company is seeking a Medical Director to review inpatient medical claims and lead clinical decision-making without the irregular hours of bedside care. Candidates should have an MD or DO, with over 5 years of clinical experience and Board Certification...Remote jobClaims
$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible extension/Conversion FTE... ...the Chief Medical Director to lead utilization management, quality improvement, credentialing... ...complex/controversial services and claims appeals. Support physician...Remote workClaims$236.5k
...clinical professional on our Medical Management/Health... ...the Chief Medical Director to direct and coordinate... ...leadership of all for utilization management, cost containment... ...quality. Reviews claims involving complex,... ...approach to work with remote, hybrid, field or office...Remote workClaimsFull timePart timeWork at officeFlexible hoursWeekend work$174.07k - $374.92k
...Aetna, a CVS Health Company, offers a remote Medical Director (Cardiology) role. This subject matter... ...Medical Director will lead all aspects of utilization review and quality assurance,... ...Responsibilities include predetermination reviews, claim determinations, and providing clinical...Remote workClaimsHourly payFull timeTemporary workLocal area- ...experience in managed care utilization and case management to... ...of the team making medical necessity and benefit... .... The position can be remote, or on-site in our New... ...office. The Medical Director will be responsible for... ...resolution of their members’ claims. Your interest and...Remote workClaimsPart timeWork at office
- ...physician to serve as Clinical Medical Director in support of CMS Healthcare... ...involving out-of-network claims Develop and maintain clinical... ...in a medical director, utilization management, or independent medical... ...VA, however we are open to remote candidates in the following...Remote workClaims
$202k - $303k
...position assists the Chief Medical Director to direct and coordinate the... ...medical leadership of all for utilization management, cost containment... ...care quality. Reviews claims involving complex, controversial... ...There may be opportunity for remote work within all jobs posted...Remote workClaims$190k - $200k
...We're seeking a board‑certified Medical Director (Internal Medicine or Family Practice... ...support our team. This role is fully remote and focuses on utilization management (UM), quality review,... ...complex/controversial services and claims appeals. Support physician committee...Remote workClaimsFull time$174.07k - $374.92k
...use of health care resources. Remote Work This role is remote;... ...Responsibilities Expand Aetna's medical management programs to address... .... Lead all aspects of utilization review and quality assurance,... ...predetermination reviews and reviews of claim determinations, providing...Remote workClaimsHourly payFull timeTemporary workLocal areaWork from home- ...Medical Director Immediate need for a talented Medical Director. This... ...located in PA, NJ, and DE (Remote). Please review the job description... ...the role including: Utilization Management The physician... ...which Independence serves as claims administrator, and on the terms...Remote workClaimsContract workTemporary workLocal areaImmediate start
$236.5k
...clinical professional on our Medical Management/Health... ...the Chief Medical Director to direct and coordinate... ...leadership of all for utilization management, cost containment... ...care quality. Reviews claims involving complex,... ...approach to work with remote, hybrid, field or...Remote workClaimsFull timePart timeWork at officeFlexible hoursWeekend work$122.44k
...in the administration of the Medical Review and Prior Authorization... ...program partners. Location Remote position. Typical work hours:... ...healthcare program management, utilization/case management, or medical... ...with pricing large stop‑loss claims in coordination with clinical...Remote workClaimsFor contractorsWork at officeMonday to Friday$200k - $270k
...to apply for the Associate Medical Director, Cardiology role at Cohere Health... ...‑based criteria while utilizing clinical acumen Clearly and... ...by Cohere Pay & Perks Fully remote opportunity with about 5% travel... ...data with post‑service claims validation, we’re creating a...Remote workClaimsFlexible hours$174.07k - $374.92k
...health care resources. This is a remote based (work at home) based anywhere in the US. The Medical Director (Ortho/Total Joint) will be a... ...You will lead all aspects of utilization review/quality assurance,... ...predetermination reviews and reviews of claim determinations, providing...Remote workClaimsHourly payFull timeTemporary workLocal areaWork from home$223.8k - $313.1k
...our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments... ..., or those experienced in Utilization Review are encouraged to... .... Travel: While this is a remote position, occasional travel to...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$221.3k - $420.5k
...Remote Medical Director - South Carolina Join to apply for the Remote Medical Director - South... ...Provides medical leadership of all for utilization management, cost containment, and... ...and health care quality. Reviews claims involving complex, controversial, or...Remote workClaimsFull timeWork at officeFlexible hoursWeekend work$79.8k - $126k
...Medical Director - Texas Licensed (5pm-9pm CT) Remote Judi Health is an enterprise health technology company providing... ...Platform (EHP), which consolidates all claim administration-related workflows... ...for Capital Rx’s clinical utilization management (UM) programs, consultative...Remote workClaimsWork at officeLocal areaShift work$174.07k - $374.92k
...Job Overview Medical Director – Behavioral Health – Special Investigations Unit (SIU) . Remote, full‑time. The position can be based anywhere... ...policies, procedures, and claims edits, and assist in finding... ...with company constituents. Utilize available resources and technology...Remote workClaimsFull timeTemporary workLocal areaFlexible hours$174.07k - $374.92k
...health care resources. Remote based (work from home)... ...in Arizona and have a medical license without... ...Arizona) In the Medical Director role you will provide... ...primarily on overseeing utilization review and quality assurance... ...reviews and review of claim determinations. This...Remote workClaimsHourly payFull timeTemporary workLocal areaWork from homeNight shiftWeekend work- ...limited to: Customer Service, Claims Processors, and... ...essential functions of the job Remote: not held to onsite... ...professional oversight for medical management activities related to utilization management, case... ...Credentialing Committee, Medical Directors Committee, and Medical...Remote workClaimsWork at office1 day per week
- ...impact in our community. The Senior Medical Director, Utilization Management is the physician leader... ...applying to this position may be hybrid or remote and can live in one of the following... ...medical necessity determinations and claim reviews. Conduct clinical reviews...Remote workClaimsLive in
$248.5k - $373k
...deliver clinical coverage and medical claims reviews. Our role is to... ...care costs. The Medical Director provides physician support to... ...clinical knowledge in various utilization management activities with a... ...enjoy the flexibility to work remotely from anywhere within the U.S...Remote workClaimsMinimum wageWork experience placementLocal area- ...expansive network reach that medical businesses need to get... ...with an exceptional remote workforce across the... ..., the Medical Director will lead a team of UM... ...in‑depth knowledge of utilization management principles,... ...prior authorization, claims appeals/denials, either...Remote workClaimsHourly payWork at officeLocal area
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