Remote Medical Director, Medicaid Appeals
CVS Health
CVS Health is seeking a Medical Director to support Medicaid appeals nationwide via a remote, work-at-home arrangement. The role centers on ensuring timely, medically sound responses to member and provider appeals and grievances.
The candidate will provide clinical leadership, chair Medicaid appeals meetings, and influence policy with a strong background in healthcare delivery and licensure across states. A MD/DO with ABMS certification is required.
#J-18808-LjbffrVacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Medical Director, Medicaid Appeals in United States vacancy
- ...clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful... ...patient-care impact. You will review medical records, identify discrepancies, provide...Remote workFull time
UnitedHealth Group
United States5 days ago - ...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 workWeekday work
United Healthcare Services Inc
United States4 days ago $223.8k - $313.1k
...our caring community The Medical Director relies on broad clinical expertise... ...to review Medicare drug appeals (Part D & B). The Medical... ...Medicare Advantage, managed Medicaid, or Commercial health insurance... ....Travel: While this is a remote position, occasional travel...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome office$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, TX9 days ago$248.5k - $373k
...Appeals And Grievances Medical DirectorAt UnitedHealthcare, we're simplifying the health care experience... ...!The Appeals and Grievances Medical Director is responsible for ongoing clinical... ...You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you...Remote workMinimum wageFull timeWork experience placementLocal areaWork from homeUnitedHealthcare
Cypress, CA6 hours ago$236.5k
...DescriptionPosition Purpose:\n Assist the Chief Medical Director to direct and coordinate the medical... ...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 Corporation
Trout Lake, WA6 hours 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 workFull timePart timeWork at officeFlexible hoursWeekend workCentene Corporation
New York, NY5 days ago$248.5k - $373k
...$248,500 - $373,000/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ...week.Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaUnitedHealth Group
Cypress, CA4 days ago- The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple... ...benefit interpretations. This role offers full remote work across the United States, with limited in-office requirements...Remote jobWork at office
$215k - $408.5k
For our client, we are seeking a Remote Medical Director, Appeals to join the team of a leader in the Hospitals & Medical Centers space. This role provides medical leadership across utilization management, quality improvement, and appeals processing in a highly regulated...Remote jobWork at officeVisa sponsorshipFlexible hours- 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 work
UnitedHealthcare
Cypress, CA5 days ago - ...CVS Health, through its Aetna subsidiary, seeks an experienced Medical Director to lead Medicare Appeals. This remote role can be based anywhere in the United States and supports a national scope, with eligibility for CVS Health's bonus and equity programs. You will...Remote work
CVS Health
United States2 days ago - ...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 work
UnitedHealth Group
Cypress, CA2 days ago - ...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 $248.5k - $373k
...Appeals And Grievances Medical DirectorAt UnitedHealthcare, we're simplifying the health care experience... ...'ll enjoy the flexibility to work remotely from anywhere within the U.S. as you... ...responsesCommunicate with UnitedHealthcare medical directors regarding appeals decision...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaUnitedHealthcare At Home
Phoenix, AZ5 days ago- ...CVS Health, through its Aetna Better Health Louisiana program, seeks a Medical Director to advance Medicaid quality, access and outcomes. This work‑from‑home role supports Louisiana while assisting other plans as needed, driving utilization management and care reviews...Remote workWork from home
CVS Health
United States3 days ago - ...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
$174.07k - $374.92k
...clinical quality and effective use of health care resources. This is a remote based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals: Direct daily work on part C appeals (both provider and member/...Remote workHourly payFull timeTemporary workLocal areaWork from homeWeekend work- 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 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
- ...Ladders seeks a Remote Medical Director - Appeals to lead medical oversight of utilization management, quality improvement, and appeals processes. The role involves reviewing complex cases, guiding medical necessity decisions, and partnering with care teams to support...Remote work
Ladders
United States3 days ago $180 per hour
...Job Description REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS \n \n $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension \n \n The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management...Remote workContract workWork at officeMonday to FridayThe Jacobson Group
West Virginia21 days ago- ...join MedStar Family Choice as Senior Health Plan Medical Director in Washington, DC. This hybrid role combines... ...site leadership four days a week with one day remote, guiding clinical strategy and operations for the Medicaid plan. You will oversee medical management,...Remote workContract work
MedStar Health
Washington DC3 days ago - 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 work
UnitedHealthcare
United States4 days ago $258k - $323k
...Join to apply for the Behavioral Medical Director - Remote role at Optum 1 day ago Be among the... ...program, including timely peer reviews, appeals and consultations with providers and... ...resources designed to aid the State Medicaid population ~ All employees working...Remote workMinimum wageFull timeWork experience placementLocal areaOptum
Eden Prairie, MN5 days ago$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into... ...services, complex case reviews, appeals, and peer-to-peer... ...medical management with Medicare/Medicaid (MLTC, MAP, D-SNP, MAPD).... ...leadership role with a hybrid schedule (3 days remote / 2 days onsite)...Remote workFull timeWork at officeMonday to FridayShift work2 days per weekMedix™
New York, NY2 days ago$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 shiftCVS Health
Springfield, IL5 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
- ...Medical Director - RemoteARC Group has an immediate opportunity for a Medical... ...! This position is 100% remote working eastern time zone business... ...Centers for Medicare and Medicaid Services (CMS) and... ...e.g., medical review staff, appeals teams) and external stakeholders...Remote workPermanent employmentFor contractorsWork experience placementLocal areaImmediate start
American Recruiting & Consulting Group
Jacksonville, FL2 days ago $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
- healthcare compliance manager United States
- clinical engineering manager United States
- medical and health service manager United States
- healthcare facilities manager United States
- medical billing supervisor United States
- home health director United States
- medical director global medical affairs United States
- clinical qa manager United States
- clinical account manager United States
- medical office supervisor United States