Remote Medical Director — Medicaid Appeals
CVS Health Corporation
New York, NY
- Remote job
CVS Health is seeking a Medical Director to support Medicaid appeals across the Southeast region. This remote-based role focuses on member and provider appeals related to medical necessity and involves chairing Medicaid appeals committee meetings. Requires an MD/DO with board certification and active licensure in FL, KY, LA, and WV, plus 5+ years in health care delivery. The position offers competitive pay and comprehensive benefits. #J-18808-Ljbffr CVS Health Corporation
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Medical Director — Medicaid Appeals in New York, NY vacancy
- UnitedHealthcare is seeking a Remote Appeals Clinician to conduct comprehensive clinical reviews of Medicaid appeals (H6516/H2060). The role requires an active Texas RN... ...evaluate records, provide independent judgments on medical necessity, and prepare detailed appeal...Remote jobMonday to Friday
- ...conduct comprehensive clinical reviews of appeals, evaluate medical records, and provide independent clinical judgment... ...documentation and collaboration within a remote team, with weekday daytime hours. Ideal candidates have Medicaid experience and familiarity with H6516/H2060...Remote jobWeekday work
$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 workMinimum wageWork experience placementLocal areaUnitedHealth Group
Cypress, CA6 days ago$236.5k
Position Purpose:Assist the Chief Medical Director to direct and coordinate the medical management... ...clinical teams, network providers, appeals team, medical and pharmacy consultants... ..., and a flexible approach to work with remote, hybrid, field or office work schedules...Remote workFull timePart timeWork at officeFlexible hoursWeekend workCentene
Austin, TX4 days ago$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 workContract workWork at officeMonday to FridayThe Jacobson Group
United States4 days ago- The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple... ...accurate benefit interpretations.This role offers full remote work across the United States, with limited in-office...Remote jobWork at office
- ...organized Manager of Clinical Appeals to lead our clinical appeals... ...background in clinical review, medical necessity denials, payer... ...government (e.g., Medicare, Medicaid) and commercial payers. Lead... ...commercial plans. Experience managing remote and/or offshore teams (...Remote work
Health Business Solutions
Florida, NY5 days ago $236.5k
...clinical professional on our Medical Management/Health Services team... ...: Assist the Chief Medical Director to direct and coordinate the... ...clinical teams, network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or office work...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work- ...classified as hybrid, onsite or remote. While the majority of our... ...provide professional oversight for medical management activities related... ...Committee, Medical Directors Committee, and Medical Management... ...Committee. Participate in the appeals and grievance processes to...Remote workFull timeWork experience placementWork at office1 day per week
- Humana Inc. is seeking a Behavioral Health Medical Director to provide clinical leadership for Medicaid behavioral health utilization management and ensure timely... ...Medicaid and may cover other markets. This fully remote position requires board-certified psychiatry, a valid...Remote job
$275k - $315k
...Job Description Title: Medical Director of Utilization Management... ...services, complex case reviews, appeals, and peer-to-peer discussions... ...management with Medicare/Medicaid (MLTC, MAP, D-SNP, MAPD). \n... ...role with a hybrid schedule (3 days remote / 2 days onsite)\n...Remote workWork at officeMonday to FridayShift work2 days per weekMedix™
New York, NY3 days ago- A prominent healthcare organization is seeking an Appeals and Grievances Medical Director to manage clinical reviews of appeals for various health plans. The role offers flexibility to work remotely. Qualified candidates should have an MD or DO, be board certified, and...Remote job
- UnitedHealth Group in Cypress, CA, is seeking an Appeals Medical Director for Radiation Oncology. This remote role involves ongoing clinical review and adjudication of appeals and grievances across multiple health plans, with the ability to work from anywhere in the U....Remote jobWork at office
- UnitedHealth Group is seeking a Medical Director to lead appeals and grievances review for UnitedHealthcare. This role involves adjudicating cases across PPO, ASO, HMO, MAPD, and PDP products, applying clinical criteria and regulatory requirements. We value MD/DO board...Remote job
- UnitedHealth Group in the United States is seeking an Appeals Medical Director in Radiology for a remote role. You will oversee clinical review and adjudication of appeals and grievances across plans, contributing to quality care and regulatory compliance.The role requires...Remote job
- ...Primary Work Location : Remote (Oregon Headquarters).... ...Reports To: Nursing Director - RN Work Location... ...managing the healthcare for Medicaid members, covered under... ...with the YCCO Chief Medical Officer (CMO) and/or... ...necessity review/appeals to ensure appropriateness...Remote workContract workFor contractorsCasual workWork at officeLocal areaFlexible hours
Yamhill Community Care
Mcminnville, OR9 days ago - UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H2060), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license...Remote jobFlexible hours
- UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review and adjudication of appeals and grievances across multiple health plans. You will apply clinical criteria, coordinate with medical directors, and help shape...Remote job
- Teamware Solutions Inc. is seeking a Medical Director to review escalated medical cases, determine medical necessity, and ensure compliance... ...with clinical guidelines and health care regulations. This 100% remote leadership role involves collaboration with multidisciplinary...Remote job
$258k - $323k
Join to apply for the Behavioral Medical Director - Remote role at Optum1 day ago Be among the first... ...program, including timely peer reviews, appeals and consultations with providers and... ...resources designed to aid the State Medicaid populationAll employees working...Remote jobMinimum wageWork experience placementLocal area$174.07k - $374.92k
...an outstanding opportunity for a Medical Director (Medical Affairs). This is a full-time, remote based, work from home opportunity.... ...reviews and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested...Remote workHourly payFull timeTemporary workLocal areaWork from homeWeekend workAfternoon shift$33.71 - $60.67 per hour
...the liaison for all statewide appeals, fair hearings, review... ...Key Details: This is a fully remote, work-from-home position open... ...recognized criteria to determine medical necessity of services requested... ...Coordinate with Medical Director(s) to clarify medical determinations...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursCentene Corporation
Dover, DE8 hours ago- ...Job Description Job Description MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity... ...between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs... ...teams (e.g., medical review staff, appeals teams) and external stakeholders....Remote workPermanent employmentFor contractorsWork experience placementLocal areaImmediate start
ARC Group
Jacksonville, FL15 days ago - ...is seeking a licensed professional to join their staff Remotely as their new Medical Director - Utilization Management. \n About the Opportunity:... ...evidence-based research. \n Review medical necessity and appeal cases. \n Analyze utilization patterns, retrospective...Remote jobMonday to FridayShift work
Tandym Health
New York, NY27 days ago $223.8k - $313.1k
...of our caring communityThe Medical Director actively uses their medical... ...Directors will learn Medicare, Medicaid, and Medicare Advantage... ...-acute care environments. A remote possibility exists of doing... ...documentation, dispute/grievance and appeals processes, and outpatient...Remote workFull timeTemporary workApprenticeshipWork at officeHome office- HCSC is seeking a physician for a remote role focused on medical policy reviews and program support. You will interact with provider communities to perform reviews for assigned areas while maintaining required licensure and board certifications. The position emphasizes...Remote job
$223.8k - $313.1k
...our caring community The Medical Director uses their medical background... .... This is a full-time, remote position with a standard schedule... ...Medicare Advantage, Managed Medicaid, or other medical management... ...contribute to grievance and appeals reviews. Some medical...Remote workFull timeTemporary workApprenticeshipLive inWork at officeWork from homeHome officeMonday to Friday$150 per hour
...Individual and Family, and Medicaid plans. Founded more... ...5 years ago as Boston Medical Center HealthNet Plan,... ...Summary The Medical Director -BH per diem will support... ...management, quality, appeals and grievances, and... ...performed in a typical remote interior/office work environment...Remote workDaily paidWork at officeFlexible hours2 days per week1 day per week$223.8k - $313.1k
...of our caring communityThe Medical Director, National Outpatient Medicare... ...documentation, coding, grievances and appeals, and outpatient services or... ...Advantage and Managed Medicaid.Utilization management... ...organizational committees.Work Style: Remote - Occasional travel to...Remote workFull timeTemporary workApprenticeshipWork at officeHome officeMonday to Friday$257.05k - $340.59k
...expects to pay starting compensation for the position of Medical Director, Appeals, Grievances & Disputes in the range of $257,050 – $340,591... ...minimum Quality of Care Management experience ~ Experience in Medicaid and Medicare managed care lines of business, with deep...Shift workKern Health Systems
Bakersfield, CA1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Director — Medicaid Appeals. Be the first to apply!
Related searches
- medical product manager New York, NY
- clinical supervisor lmft lcsw New York, NY
- behavioral health supervisor New York, NY
- clinical program manager New York, NY
- lead clinical data manager New York, NY
- assistant clinical director New York, NY
- associate medical director New York, NY
- occupational health manager New York, NY
- director behavioral health New York, NY
- junior clinical data manager New York, NY