Remote Medical Director - Pediatrics & Utilization Review
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- Remote job
Optum, a global health services leader, seeks a Medical Director to support Enterprise Clinical Services. You will guide clinical coverage determinations, ensure quality and cost-effective care, and collaborate with leaders to optimize processes. This remote role offers flexibility to work from anywhere in the United States, with responsibilities including coverage reviews, documentation, peer discussions with providers, and cross-team collaboration to ensure timely, accurate determinations for #J-18808-Ljbffr Tnafp
- ...To support Utilization Management operations, the full-time Utilization Review Medical Director will conduct clinical reviews of Durable Medical Equipment (DME) requests remotely, ensuring compliance with Medicare and Medicaid guidelines while maintaining productivity...Remote workFull time
- ...Medical DirectorCurative is seeking an enthusiastic and highly skilled Medical Director to join our growing team. This pivotal role will... ...overseeing and performing utilization reviews, prior authorizations, and... ...peer discussions. This is a remote position requiring a "...Remote workFull time
- ...operational areas of the Utilization Management (UM) program including... ..., and retrospective reviews. As a Medical Director, UM you ensure all patient... ...Work Arrangement ~ Fully remote; must be willing to work... ...required in family medicine, pediatrics, internal medicine,...Remote workContract workLocal areaFlexible hoursWeekend work
- Integra Partners seeks an experienced Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a remote UM environment. You will ensure decisions meet Medicare/Medicaid guidelines and internal policies while maintaining timely throughput and...Remote job
$150 per hour
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support... ...Working Conditions and Additional Expectations: Remote role requiring consistent availability during standard business...Remote workHourly payFull timeContract workTemporary workPart timeLocal area- Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast...Remote jobFull time
- ...Hospital Experience by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior... ...Continued Stay Reviews Determine Medical Necessity per Evidence-Based... ...Safety Goals Additional Skills remote UR work CA and Medi-Cal...Remote work
$275k - $325k
...growing, TOI is changing oncology for the better. Utilization Management Medical Director OncologyWork Location: REMOTE (work from home)California Nevada Arizona Oregon... ...focus on direct utilization management for case review and clinical decision making. In this...Remote workWork from home- ...Description Job Description Medical Director of Prior Authorization and Utilization Management - Palm Springs, California... ...prior authorization, concurrent review, and utilization management... ...position can be structured as a hybrid remote role - you would not necessarily...Remote workPermanent employmentTemporary workRelocation package
- ...WellMed, part of the Optum family, is seeking a Medical Director for Utilization Management to support utilization determinations and identify trends... ...current with CMS criteria, and participating in case reviews and medical necessity determinations. Qualified candidates...Remote work
$248.5k - $373k
...00/yearJob Area: Medical & Clinical OperationsCompany... ...medical claims reviews. Our role is to... ....The Medical Director provides... ...knowledge in various utilization management activities... ...to work remotely * from anywhere within... ...Internal Medicine and Pediatrics OR Family...Remote workMinimum wageFull timeWork experience placementLocal area- ...Bickham Services Unlimited, LLC seeks a Medical Director, Utilization Management for a 6-9 month contract based in Henderson, NV, with remote work option. Immediate start favored for reviewing inpatient and post-acute care decisions for Commercial and Medicare Advantage...Remote workContract workImmediate start
- ...UnitedHealth Group (Optum) is seeking a Medical Director to provide physician support to Enterprise Clinical Services, shaping clinical coverage determinations, quality improvement, and cost-effective care for members. You will collaborate with network and non-network...Remote work
$223.8k - $313.1k
...of our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director... ..., or those experienced in Utilization Review are encouraged to apply.... ...information. Travel: While this is a remote position, occasional travel to...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$173k - $250k
...Job Summary: The Medical Director will report to the... ...Medical Director of Utilization Management, Member Appeals... ...medical necessity reviews, evaluation of medical... ...in You: • Full-time remote work • Competitive... ...• Internal Medicine-Pediatrics (Med Peds) • Family...Remote workFull timeWork at officeFlexible hours$240k - $250k
...Medical Director Utilization ManagementWe are looking for physicians who have expertise in Internal Medicine... ...appropriateness of services by reviewing clinical information and applying evidence... ...and perspectives.This is a remote-first role that may require travel to...Remote workFlexible hours- ...Utilization Review RN - Remote Utilization Review RN - REMOTE position. This position is Part time... ...Conduct clinical reviews and review medical records daily during admission for all... ...services, emergency and trauma care, pediatrics and neonatal intensive care. Our not...Remote workPart timeLocal areaDay shift
- ...Summary: The Registered Nurse in Utilization Review is responsible for... ...This role involves assessing medical necessity, conducting admission... ...specialties such as ICU, MSP, and Pediatrics. The position requires a... ..., and mouse to complete remote and onsite work efficiently....Remote workCasual workDay shift
$248.5k - $373k
...,000.00/yearJob Area: Medical & Clinical OperationsCompany... ...physician to join our Utilization Management team. Optum... ...and live.The Medical Director for Utilization... ...the flexibility to work remotely * from anywhere within... ...processesParticipates in case review and medical necessity...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$275k - $300k
The Oncology Institute is seeking a Medical Director for Utilization Management Oncology to provide strategic oversight and support key clinical initiatives. This remote role involves conducting medical reviews of oncology treatment plans and ensuring compliance with evidence...Remote job- Starling Oncology is seeking a Medical Director to provide clinical expertise in utilization management for oncology care. You will review and guide medical necessity decisions, collaborating with physicians, operations, and payers to optimize outcomes and value-based care...Remote job
- CVS Health is hiring a Radiation Oncology Medical Director to oversee oncology utilization, policy implementation, and review processes in a remote, home-based role. The position supports the enterprise oncology initiatives with emphasis on prior authorization, peer-to-...Remote jobWork from home
- UnitedHealth Group seeks a Medical Director to lead clinical coverage reviews and benefit determinations within Enterprise Clinical Services... ..., communication, and remediation of utilization management. You can work remotely from anywhere in the United States, with responsibilities...Remote job
- Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will align clinical decisions and... ..., and organizational standards in a fully remote role based in the United States. You will...Remote jobPart time
- The Oncology Institute is seeking a Medical Director to provide clinical expertise in assessing medical necessity, appropriateness... ..., and efficiency of oncology care with a focus on utilization management for case reviews and clinical decision making. In this collaborative...Remote job
- ...Group in Minnesota seeks a Medical Director to provide physician support... ...determinations and medical necessity reviews. The role partners with a... ...high-quality care, advances utilization management, and communicates... ...and non-network physicians. Remote work from anywhere in the U....Remote job
$248.5k - $373k
...medicine physician to join our Utilization Management team. Optum is a... ...work and live. The Medical Director for Utilization Management will... ...processes Participates in case review and medical necessity... ...*All employees working remotely will be required to adhere to...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- ...Medical Director Utilization Management (Payer Side Experience Required)- (Remote) Duration: 30 Weeks with possible extension Location: Pittsburgh, PA Schedule: Monday Friday... ...responsible for conducting medical necessity reviews, appeals, and escalated case evaluations...Remote workFull timeContract workPart timePrivate practiceMonday to FridayFlexible hours
$222.75k - $267.3k
## Medical DirectorApply: Remote: Full time: Posted Yesterday: JR100123About Altais... ...patients. The Medical Director of Utilization and Medical Management... ...Committee, the Peer Review and Patient Safety Committee... ..., General Surgery or Pediatrics.* A minimum of twelve (1...Remote workFull timeWork at officeLocal areaFlexible hours- ...required to address utilization review cases. Roles and Responsibilities... ...of cases involving medical decisions and quality... ...with Medical Director on CM and UM cases.... ..., primary care/pediatrics, and oncology. You... ...Requirements This is a remote position. Our whole...Remote workLive inFlexible hoursWeekday work
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