Remote Appeals Medical Director — Health Policy & Quality
Texas Health Institute
UnitedHealth Group in the United States is hiring for a high-level clinical specialist to review appeals and manage quality programs. This role offers remote work from anywhere in the U.S. and opportunities to collaborate across clinical and business teams.
Responsibilities include case review for appeals, regulatory responses, and communications with medical directors. Required credentials include an active MD/DO license and board certification, with 5+ years of clinical practice and 2+ years
#J-18808-Ljbffr$248.5k - $373k
...00.00Job Area: Medical & Clinical OperationsCompany... ...the health care experience... ...barriers to quality care. The work... ...flexibility to work remotely * from anywhere... ...:The Appeals and Grievances Medical Director is responsible... ...criteria of medical policies.Perform Department...Remote workQualityPolicyMinimum wageWork experience placementLocal areaWork from home- ...Group is seeking a senior Appeals and Grievances Medical Director to lead clinical review... ...case reviews for multiple health plans, address regulatory... ...to interpret benefits and policies. Requires MD/DO, board... ...clinical plus 2+ years in quality management. #J-18808-Ljbffr...Remote jobQualityPolicyWork from home
$195.2k - $341.6k
...Overview Job Summary: The Medical Director is responsible for supporting... ...physician review for clinical appeals cases Participate in the... ...suspected of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participate...Remote jobQualityPolicyHourly payWork at officeWeekend workAfternoon shift$236.5k
...professional on our Medical Management/Health Services team.... ...Medical Director at Centene provides... ...to ensure high-quality, cost-effective... ...participates in the appeals process, ensuring... ...Complies with all policies and standards.... ...approach to work with remote, hybrid, field...Remote workQualityPolicyFull timePart timeWork at officeFlexible hours$236.5k
...professional on our Medical Management/Health Services team.... ..., and medical quality improvement activities... ...Chief Medical Director in planning and... ...goals and policies to improve quality... ...network providers, appeals team, medical... ...approach to work with remote, hybrid, field...Remote jobQualityPolicyFull timePart timeWork at officeFlexible hoursWeekend work- ...Manager of Clinical Appeals to lead our... ...execution, ensuring quality and compliance, and... ...clinical review, medical necessity denials,... ...necessity criteria, payer policies, NCDs/LCDs, and... ...in Nursing, Health Administration, or... ...Experience managing remote and/or offshore teams...Remote workQualityPolicy
$174.07k - $374.92k
...building a world of health around every... ...prioritize safety and quality in everything we do... ...). **This is a remote based (work at home... ...of this Medical Director role are related to Medicaid Appeals You will support... ...experience in Medicaid Policy and the use of Dynamo...Remote workQualityPolicyHourly payFull timeTemporary workLocal areaWork from home$102.18k
...Supervisor, Appeals and Grievances Clinical... ...in 1997, L.A. Care Health Plan is an independent... ...provide access to quality health care for... ...regulations, policies, protocols, and procedures... ..., a hybrid remote schedule, occasional... ...Retirement Plans Medical, Dental and Vision...Remote workQualityPolicyFull timeShift workWeekend work$386.5k
.../yearJob Area: Medical & Clinical OperationsCompany... ...the health care experience... ...barriers to quality care. The work... ...Management. The Medical Director, Clinical AI... ...ensure medical policies are accurately... ...to work remotely * from anywhere... ...from production, appeals, audits, and quality...Remote workQualityPolicyMinimum wageFull timeWork experience placementLocal area$248.5k - $373k
...00.00Job Area: Medical & Clinical OperationsCompany... ...improve health outcomes by... ..., the Medical Director provides... ...for the overall quality, effectiveness... ...discussions and provider appeals. In addition,... ...of policies and procedures... ...flexibility to work remotely * from anywhere...Remote workQualityPolicyMinimum wageWork experience placementWork at officeLocal area$280.84k - $393.18k
...Reporting to the Vice President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical... ...to key activities including quality management, grievance and appeals, delegation oversight, and... ...work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho...Remote workQualityPolicyTemporary workLocal area$174.07k - $374.92k
...building a world of health around every... ...prioritize safety and quality in everything we do... ...opportunity for a Medical Director. Ready to take... ...company? This is a remote Work at Home position... ...MPO (Medical Policy & Operations) you... ...in support of the appeal process, clinical...Remote workQualityPolicyHourly payFull timeTemporary workLocal areaWork from home$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible... ...management, quality improvement, credentialing, and appeals for high-volume inpatient... ...needed. Consult on SUD policy and MCM cases when... ...function: Management and Health Care Provider...Remote workQualityPolicy- ...Medical DirectorCurative is seeking an... ...skilled Medical Director to join our... ...discussions. This is a remote position... ...established medical policies, and evidence-... ...and appeal processes.Collaborate... ...Participate in quality improvement initiatives... ...electronic health records (EHR)...Remote workQualityPolicyFull time
$320k - $350k
...General Brigham Health Plan Holding... ...groundbreaking medical discoveries and... ...Senior Medical Director serves as a key... ...to ensure high‑quality, cost‑effective... ...escalated cases, appeals, and grievances... ...and ensure UM policies align with regulatory... ...(if applicable)Remote TypeRemoteWork...Remote workQualityPolicyFull time$173k - $250k
...join the WellSense Health Plan, a growing regional... ...Summary: The Medical Director will report to the... ...Management, Member Appeals & Grievances, and Medical Policy (Senior Medical... ...trend management, quality, appeals and grievances... ...You: * Full-time remote work *...Remote workQualityPolicyFull timeWork at officeFlexible hours$286.07k - $353.38k
...Join Martin's Point Health Care - an innovative, not... ...Vice President, Medical Director, Health Plan provides... ...Plan, with a focus on quality, affordability, compliance... ...quality, pharmacy, medical policy, payment policy, and... ..., including clinical appeals and grievances, using...Remote workQualityPolicyFull timeHome office$79.8k - $126k
...About Judi Health Judi Health is... ...consolidating pharmacy and medical benefit... ...Lead Medical Director. This position... ...and appeals) and responds to... ...Health's coverage policies. Medical Directors... ...delivering high-quality work Minimum... ...of the job. Remote, US Salary Range...Remote workQualityPolicyWork at officeLocal areaFlexible hoursShift work- ...Overview The Contractor Medical Director (CMD) is... ...Administrative Law Judge appeals hearings, and... ...integrity and high‑quality care for Medicare... ...on coverage and MR policy issues and interact... ...experience in the health insurance industry... ...Health and Hospice. Remote Work Requirements...Remote workQualityPolicyContract workFor contractorsLive inLocal areaImmediate start2 days per week
- ...Medical Director, Utilization Management The Medical Director... ...comprehensive high-quality health care to UPMC Health... ...members. This fully remote role will be responsible... ...with the established policies of the Health Plan.... ...grievances, provider appeals, and potential...Remote workQualityPolicyWork at office
- ...Altais is seeking a Medical Director of Utilization and Medical Management for a remote, one-month opportunity.... ...leadership team to ensure high-quality, cost-efficient care... .... You will lead UM policy development, chair... ...plans on benefits and appeals, guiding physician...Remote jobQualityPolicy
- ...clinical strategy, medical management, and... .... Partner with Quality, Utilization... ..., Behavioral Health, Provider Network... ...medical policy, clinical guidelines... ...grievance and appeals clinical reviews... ...role (Medical Director or Deputy) specific... ...(onsite/hybrid/remote with periodic...Remote workQualityPolicyContract workRelocation
- ...UnitedHealth Group is hiring for a remote-friendly clinical leadership role overseeing appeals and grievances across PPO, HMO, MAPD... ...emphasizes collaboration with medical directors and network management to improve access, quality, and outcomes. The role requires...Remote jobQuality
$248.5k - $373k
...directly improve health outcomes by connecting... ...to work remotely from anywhere within... ...Work to improve quality and promote evidence... ...Work with medical director teams focusing on... ...coverage review, member appeals clinical review,... ...Group's Telecommuter Policy Compensation...Remote jobQualityPolicyMinimum wageWork experience placementLocal area- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and... ...and grievances across multiple health plan products. This role offers remote work from anywhere in the U.S... ...design and patient care quality. Responsibilities include case...Remote jobQuality
- ...Remote Healthcare Medical Director 100% Remote in the 28 states - North... ...Commercial, MA, FEP, and Appeals. Would cover call on... ...vary across the Health Care division, dependent... ...reimbursement and policy Care management (... ...(Credentialing) Quality model design and analysis...Remote workQualityPolicy
$206.01k
...Behavioral Health Medical Director Why should you join the BlueCross... ..., utilization review/quality assurance, directing... ...implementing medical policies and standards,... .../week) Monday-Friday REMOTE in South Carolina. You... ...physician review (UM, Appeals, CM) - reviews physician...Remote workQualityPolicyFull timePart timeFor contractorsWork experience placementLocal areaMonday to Friday$258k - $323k
...apply for the Behavioral Medical Director - Remote role at Optum 1 day... ...directly improve health outcomes by connecting... ...timely peer reviews, appeals and consultations with... ...Clinical, Network and Quality staff. At Optum, our... ...Group’s Telecommuter Policy Compensation for this...Remote jobQualityPolicyMinimum wageFull timeWork experience placementLocal area- Health Wealth Safe is seeking an Appeals and Grievances Medical Director to review medical appeals and grievances across health plan... ...and network staff on access, quality, and coverage issues, participates... ...benefits and flexible remote work. #J-18808-Ljbffr Health...Remote jobQualityFlexible hours
$281.11k
...Medical Director (Part-Time) Main Office - Santa... ...Part Time Category Health Services... ...for utilization, quality, care management... ...work a hybrid or remote schedule depending... ...review, grievances, appeals, and other medical... ...needed; develops UM policies and procedures in...Remote workQualityPolicyContract workPart timeWork at officeLocal areaRelocationRelocation package
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