Remote Appeals Medical Director | Health Policy & Quality
UnitedHealthcare
- Remote job
UnitedHealthcare is seeking a Medical Director to lead appeals and grievances review for multiple health plans. You will adjudicate cases, apply clinical criteria, and ensure compliant, patient-centered decisions from a remote setting. This role requires MD/DO with active license, ABMS/AOBMS board certification, 5+ years clinical practice, and 2+ years in quality management. You will collaborate with medical directors, participate in committees, and drive process improvements while working from #J-18808-Ljbffr UnitedHealthcare
$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- ...experienced clinician to join our remote team. You will review appeals, respond to regulatory... ..., and coordinate with medical directors to interpret benefits and... ..., and a track record in quality management. Expect... ...opportunities to influence policy while maintaining high standards...Remote jobQualityPolicy
- ...re simplifying the health care experience, creating... ...barriers to quality care. The work you... ...Work at home! The Appeals and Grievances Medical Director is responsible for... ...flexibility to work remotely from anywhere within... ...criteria of medical policies Perform Department...Remote jobQualityPolicyWork from home
- ...clinical specialist to review appeals and manage quality programs. This role offers remote work from anywhere in the U.S.... ...responses, and communications with medical directors. Required credentials include... ...practice and 2+ years #J-18808-Ljbffr Texas Health InstituteRemote jobQualityPolicy
$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
$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
.../yearJob 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 wageFull timeWork experience placementWork at officeLocal area$248.5k - $373k
.../yearJob 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 wageFull timeWork experience placementWork at officeLocal 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$190k - $200k
...a board‑certified Medical Director (Internal Medicine... ...This role is fully remote and focuses on... ...management (UM), quality review, and clinical... ...services and claims appeals. Support physician... ...Consult on SUD policy and MCM cases when... ...AmBetter or other health plan operations....Remote workQualityPolicyFull time$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,... ...'s Telecommuter Policy Compensation...Remote workQualityPolicyMinimum wageWork experience placementLocal area$195.2k - $341.6k
...Medical Director The Medical Director is responsible for supporting staff... ...review for clinical appeals cases Participate in the evaluation... ...of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participates...Remote workQualityPolicyHourly payWork at officeWeekend workAfternoon shift$230.6k - $384.4k
...Medical Director The job profile for this position is Medical... ...challenges in health care. As a manager of... ...principles Work to achieve quality outcomes for customers... ...in all levels of the Appeal process as appropriate... ..., developing medical policies and evaluating new technologies...Remote workQualityPolicyLocal areaWork from home$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- 100% Remote in the 28 states - North... ...from accredited medical school Industry... ..., MA, FEP, and Appeals. Would cover... ...application of a Medical Director's knowledge and... ...across the Health Care division,... ...and policy Care management... ...Credentialing) Quality model design...Remote workQualityPolicy
- ...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
- ...Medical Director ARC Group has an immediate opportunity... ...position is 100% remote working eastern... ...with Medicare policies, reviewing... ...medical review staff, appeals teams) and external... ...Strengthen the quality improvement procedures... ...in the health insurance industry...Remote workQualityPolicyPermanent employmentFor contractorsWork experience placementLocal areaImmediate start
$110 - $130 per hour
Title: Medical Director Location: Remote Duration: 6 Months with possible extension... ...management, quality improvement, credentialing, and appeals for high-volume inpatient... .... Consult on SUD policy and MCM cases when required... ...: Management and Health Care Provider Industries...Remote workQualityPolicy- ...directly contribute to the health and well-being of... ...Job Summary The Medical Director will serve as a clinical... ...limited to medical policy development, quality management, and... ...is eligible to work remotely, hybrid or onsite in... ...concurrent review, appeals processes, and claim...Remote workQualityPolicyWork at officeImmediate startRelocation
- ...to championing the health and well-being of... ...strategies that promote medical management,... ...satisfaction, improvement to quality outcomes while... ...may be hybrid or remote and can live in... ...management appeals, including first-... ...participation in clinical and policy team activities....Remote workQualityPolicyPrivate practiceLive in
- The Medical Director, Clinical Payment Integrity provides... ..., reimbursement policy interpretation,... ...bridge between the health plan, providers, and... ...Management, Quality, Network Management... ...validation audits, appeals, disputes, and escalated... .... Fully Remote: This role is designated...Remote workQualityPolicyWork at office
- ...apply for the Senior Medical Director role at Iovance Biotherapeutics... ..., manufacturing, quality assurance, regulatory,... ...’ core values, policies, procedures, and business... ...an accommodation. #LI-remote Seniority level Seniority... ...Director (REMOTE Appeals Medical Director - Pacific...Remote workQualityPolicyFull time
- 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 an...Remote jobQuality
$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- ...company is hiring a Physical Health Medical Director to work remotely in North Carolina. The... ...position ensures high quality, evidence based medical... ...reviews, concurrent reviews, appeals, and level of care... ...processes-as defined by approved policies, desk procedures, and...Remote workQualityPolicyTemporary workWork experience placementWork at officeRelocationFlexible hoursWeekend work
- ...Clinical professional responsible for leading medical management, quality improvement, and credentialing functions within a health services team. Responsibilities Provide... ...clinical teams, and review complex cases and appeals. Develop physician education programs and identify...Remote jobQuality
- ...Vālenz ® Health is the platform to simplify... ...costs, improve quality, and elevate the... ...As the Part-Time Medical Director, you'll provide physician... ..., medical policies, and review processes... ...determinations, appeals, and other... ...This is a fully remote position, and we’...Remote workQualityPolicyPart timeImmediate startFlexible hours
$231.9k
Join to apply for the Remote Medical Director - California role at... ...our Medical Management/Health Services team.... ...medical management, quality improvement and credentialing... ...goals and policies to improve quality and... ..., network providers, appeals team, medical and pharmacy...Remote jobQualityPolicyFull timeWork at officeFlexible hoursWeekend work
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