Medical Director, Claims & Utilization Review
Sustainable World, Inc.
UnitedHealth Group's Optum division seeks a Medical Director to provide physician guidance to Enterprise Clinical Services, leading clinical coverage determinations and utilization management with emphasis on quality and cost effectiveness. You will collaborate with network and non-network providers, participate in daily rounds, and document findings in accordance with policies and regulatory requirements while promoting evidence-based medicine. #J-18808-Ljbffr Sustainable World, Inc.
- UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services. The role focuses on clinical knowledge applied to benefit coverage determinations and cost-efficient, high-quality care. You will work with network and non-network...Claims
$248.5k - $373k
...00 - $373,000/yearJob Area: Medical & Clinical OperationsCompany... ...clinical coverage and medical claims reviews. Our role is to empower... ...health care costs.The Medical Director provides physician support to... ...clinical knowledge in various utilization management activities with a...ClaimsMinimum wageFull timeWork experience placementLocal areaRemote work- Optum seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing on post-service benefit determinations and medical necessity decisions. You will lead clinical reviews, collaborate with hospital networks, and contribute to cost-effective...ClaimsRemote job
$18 - $20 per hour
...Workplaces in Financial Services & Insurance Utilization Review Coordinator PRIMARY PURPOSE : To... ...demographics and UR information into claims or clinical management system;... ...education required. Customer service in medical field preferred. Workers compensation,...ClaimsWork at officeLocal areaFlexible hours- Optum, a global health care company, is seeking a Medical Director to provide physician leadership for Enterprise Clinical Services. You will guide clinical coverage determinations, collaborate with network and non-network physicians, and help drive cost-effective, high...ClaimsRemote job
- ...for complex, disputed, or escalated medical review determinations across the CMS... ...Background in health insurance, utilization review, or healthcare claims processing, including familiarity... ...Qualifications Prior Contractor Medical Director or Medical Director experience at...ClaimsFull timeFor contractorsWork at officeLocal areaRemote work
- Optum, a part of UnitedHealth Group, seeks a Medical Director to provide physician support for Enterprise Clinical Services. You will lead clinical reviews for benefit determinations, collaborate with leadership to implement processes, and ensure high-quality, cost-effective...Claims
$97k - $189k
...most complex, highest exposure commercial claims for a specialized line of business.... ...manages timely and adequate reserves by reviewing and interpreting policy language and partnering... ..., please visit cnabenefits.com.CNA utilizes AI-enabled technology during the recruiting...ClaimsFull timeWork experience placementWork at officeLocal areaFlexible hoursShift work$148.75k - $175k
...implementation, monitoring, and review of C&W compliance/performance.... ...practices and equipment and utilize them in the day-to-day trainingEnsure... ...Workers Compensation (WC) claims tracking, investigation, and... ..., e.g., auditing, training, medical, and OSHA recordsParticipate in...ClaimsMinimum wageFull timeLocal areaFlexible hours- ...Responsible for carrying out medical necessity reviews on all designated referrals... ..., Customer Service, Claims, Contracts and Benefits - Appeals... ...as outlined above. Utilizes established criteria to perform... ...to immediate supervisor or Director of Regional Compliance. Assures...ClaimsContract workReliefWork at officeLocal areaImmediate startWeekend work
- Commence seeks a full-time Medical Director-level physician for a hybrid office/remote role focused on Medicare review and coverage determinations. You will lead medical review... ...residency, with experience in health insurance or claims processing and strong CMS-directed...Remote jobFull timeWork at office
- Optum, a part of UnitedHealth Group, is seeking a Medical Director to provide physician support for Enterprise Clinical Services, shaping benefit... ...-quality care. Responsibilities include conducting coverage reviews, documenting findings, and engaging in peer-to-peer...ClaimsRemote job
$130k - $150k
...Experience . Real Chemistry is looking for a Medical Director, Publications to join our growing team!... ...deliverables Lead or direct writing, review, and refinement of manuscripts,... ...make payments to any unverified sources claiming to be connected to Real Chemistry. We are...ClaimsWork experience placementWork at officeLocal areaRemote work2 days per week$25 per hour
Medical Review Specialist Location: Atlanta, GA Pay Rate: $25.00 per hour Schedule: 8:30 AM... ...medical records, billing documents, and claims to prepare accurate reports using... ...schedules, CPT, ICD-10, CMS guidelines, utilization review, and billing compliance standards...ClaimsHourly payWeekly payFor contractorsWork at officeLocal area- ...Utility Locator SupervisorUtility Locator SupervisorCompany: eX2... ...company matching 401(k) plans and medical, dental, vision and life... ...team.• Technical Oversight: Reviewing as-built engineering drawings... ...documenting evidence for liability claims.• Locator Audits: Conduct...ClaimsFor contractorsRemote workWork from homeShift workAfternoon shift
- ...discharge planning activities and medical necessity reviews on all behavioral health,... ...outpatient services utilizing established criteria and guidelines... ..., Member Services, Claims, Contracts and Benefits - Appeals... ...to immediate supervisor or Director of Regional Compliance....ClaimsFull timeContract workWork at officeLocal areaImmediate startShift work
- ...Quality Reviewer Remote Role | Nationwide Ready to ensure quality and accuracy across every claim? Be the expert who sets the standard for excellence... ...Be a Trusted Resource: Utilize your Xactimate and... ...benefits* offered include: ~ Medical, Dental and Vision Plans...ClaimsRemote work
$59k - $75.05k
...Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post... ..., pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing... ...long period of computer work while utilizing multiple computer screens at one...ClaimsFull timeWork at officeLocal areaFlexible hours- ...safety, risk management, credentialing, peer review, and regulatory compliance. Serving as a... ...the development, collection, and utilization of quality performance metrics to guide... ...utilization reviews, clinical record audits, claim denials, and member satisfaction surveys...ClaimsLocal areaImmediate startShift work
- ...application process. Review Nurse, Pediatric Review... ...for the complete medical review for Pediatric Programs... ...Management and Utilization Review Contract (MMURS... ...providers with resolution of claims edit issues as needed.... ...further referral to Director, Utilization Review...ClaimsFull timeContract workTemporary workWork at officeRemote work
- ...Hmong Chinese Language Document Reviewer Employment Type: Full Time, Mid-Level Department... ..., rules to show cause, proofs of claim, motions for summary judgment, dismissals... ...variety of written documents and materials utilizing a wide range of office software...ClaimsFull timeWork at officeFlexible hours
- ...risk management.The Sr Claims Consultant is... ...for our clients, and is utilized as a trainer, mentor with... ...Schedules and conducts claim reviews with clients and... ...appropriate Advisors, Director of Risk Mitigation and... ...colleagues who need them for medical or religious reasons....ClaimsFull timeContract work
$150k - $185k
...With 98% of cyber insurance claims in the past five years coming... ...backgrounds and report to our Director, Pricing (Eric Murphy). You’ll... ...the businessYou’ll have utilized the existing Cyber and Tech E... ...KPIs, developed benchmarks, and reviewed existing pricing segmentation...Claims$72k - $141k
...direction manages a team of claims professionals for our General... ...monitoring team performance, reviewing and interpreting data analytics... ...RelationshipTypically Director or aboveSkills, Knowledge & AbilitiesKnowledge... ...senior management.Ability to utilize data and analytics to measure...ClaimsFull timeWork experience placementWork at officeLocal area$72k - $141k
...currently seeking a Complex Claims Consultant in our Financial Lines... ...and coordination. While utilizing claims policies and guidelines... ...Individual in this position will also review coverage, assess liability... ...RelationshipTypically Director or aboveSkills, Knowledge & AbilitiesAdvanced...ClaimsFull timeWork experience placementWork at officeLocal areaShift work$25 per hour
Staffmark Group in Atlanta, GA seeks a Medical Review Specialist to review medical records, billing documents, and claims for accurate reports and adjudication in line with industry guidelines. The role offers $25.00 per hour, a 8:30 AM to 5 PM schedule, and a professional...ClaimsHourly pay$112.7k - $193.2k
...provides guidance and support for utilization management related to advanced... ...for each member Work with medical director teams focusing on inpatient care... ...management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical...ClaimsRemote jobMinimum wageFull timeWork experience placementLocal area$47k - $78k
...defined authority limits to manage commercial claims of low to moderate complexity and... ...establishes timely and adequate reserves by reviewing and interpreting policy language,... ...benefits, please visit cnabenefits.com. CNA utilizes AI-enabled technology during the recruiting...ClaimsWork experience placementWork at officeLocal areaFlexible hours$63.8k - $105.4k
...Auto Physical Damage Claims Estimator Taking care of our customers, our communities... ...achieve optimal outcome on every file. Reviews physical damage documents for... ...Electronically audits vehicle estimates utilizing technical expertise and information gathered...ClaimsTemporary work- Senior Director, Health & Welfare Benefits CRH is a leading global diversified building... ...relationships for the following benefits plans: Medical Plan Prescription Drug Benefits... ...senior management. Ensure audits and reviews of claims and service performance for accuracy....ClaimsWork at office
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