Remote Medical Director, Claims & Utilization Review
RXinsider
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 physicians to ensure compliant, evidence-based decisions.
You will lead clinical rounds, communicate effectively, and drive patient-centered care while advancing operational policies in a large, multi-disciplinary team.
#J-18808-Ljbffr$240k - $250k
...Medical Director Utilization Management We are looking for physicians who have... ...appropriateness of services by reviewing clinical information and... ...perspectives. This is a remote-first role that may require... ...authorization data with post-service claims validation, we're creating...Remote workClaimsFlexible hours$223.8k - $313.1k
...our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments... ..., or those experienced in Utilization Review are encouraged to... .... Travel: While this is a remote position, occasional travel to...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- ...Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides... ...planning and utilization review.Responsibilities:•... ...concurrent and retrospective medical necessity and/or compliance... ...precertification, reimbursement and claim denials/appeals.•...Remote workClaims
- ...seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule... ...Monday - Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing...Remote workClaimsFor contractorsMonday to FridayFlexible hours
$248.5k - $373k
...deliver clinical coverage and medical claims reviews. Our role is to empower... ...health care costs. The Medical Director provides physician support... ...knowledge in various utilization management activities with... ...skills *All employees working remotely will be required to adhere...Remote jobClaimsMinimum wageFull timeWork experience placementLocal area- 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
- ...Medical Director Curative is seeking an enthusiastic and highly skilled Medical Director... ...responsible for overseeing and performing utilization reviews, prior authorizations, and making... ...peer-to-peer discussions. This is a remote position requiring a "roll up your sleeves...Remote workFull timeFlexible hours
$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
- ...Description Job Description The utilization review and management (UM)... ...MedHealth contracted facilities are medically necessary, clinically... ...logging and documentation of claims along the process chain. #... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
- UnitedHealth Group's Optum unit seeks a Medical Director to lead the Focus Claims Review program, overseeing medical services, provider discussions, and policy... ...and coordination across reviews. You can work remotely from anywhere in the U.S. The position requires an active...Remote jobClaims
- ...New Horizons is seeking an Utilization Review Specialist , who will be responsible... ...portal, review patients medical record via EMR to ensure criteria... ...or denial of accounts to Director of Revenue or designee Trends disputed claims by payor Obtain & follow authorization...Remote workClaimsLocal area
- Optum seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing... ...decisions. You will lead clinical reviews, collaborate with hospital networks,... ...practice, and strong communication skills; remote-friendly with comprehensive benefits....Remote jobClaims
$18 - $20 per hour
...Utilization Review Coordinator PRIMARY PURPOSE: To assign utilization review requests; to verify... ...demographics and UR information into claims or clinical management system; maintains... ...required. Customer service in medical field preferred. Workers compensation,...Remote workClaimsWork at officeLocal areaFlexible hours- ...5f5;}Remedial Pro is a specialized medical billing company serving substance abuse... ...benefits verification, billing and claims submission, and utilization review, we help treatment centers optimize... ...a desk and working on a computer.Remote PositionBenefits:• Competitive...Remote workClaimsHourly payWork at office
- ...Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career... ...clinical information to determine the medical necessity, appropriateness, and... ...related activities. Review medical claims and pre-determinations for medical necessity...Remote workClaimsFull timeTemporary workSummer workWork at officeFlexible hours
$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical information... ...patient treatment, certifies the medical necessity and assigns an... ...and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS... ...concern to the appropriate claims staff/customer Collects...Remote workClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...efficiency of the use of Medical Services for Long-... ...and concurrent review. Provides monthly... ...setting by utilizing the applicable medical... ...Works with medical directors in interpreting... ...care and accurate claims payment. May also... ...Additional Info: *possible remote opportunity after...Remote workClaimsContract workMonday to FridayFlexible hours
$70.7k - $133.08k
...A Glance Location: Remote Facility: Ascension... ...Thomas Department: Utilization Management Schedule:... ...Comprehensive health coverage: medical, dental, vision,... ...Admissions & Medical Necessity Review: Evaluating service... ..., and managing claim denials or appeals....Remote workClaimsFull timeLocal area$1,966 per week
...and benefits, including medical, dental, vision, long-... ...Holidays Work-life balance. Remote/hybrid setting (once... ...: This individual will utilize clinical knowledge and... ...to a second level reviewer. This individual interfaces... ...'s status, benefit and claim concerns, and validation...Remote workClaimsFull timeTemporary workPart timeWork at officeWork from homeMonday to FridayFlexible hours- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workClaimsFull time
$248.5k - $373k
...73,000/yearJob Area: Medical & Clinical OperationsCompany... ...coverage and medical claims reviews. Our role is to... ...costs.The Medical Director provides physician support... ...knowledge in various utilization management activities... ...flexibility to work remotely * from anywhere...Remote workClaimsMinimum wageFull timeWork experience placementLocal area- ...Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment... ...requirements. This role reviews medical information submitted by... ...in the office and three days remote. Candidates must also have... ...physicians, healthcare providers, claims professionals, and internal...Remote workClaimsWork at officeImmediate startFlexible hours2 days per week
- ...(GRC) is hiring a full-time Utilization Review Liaison! In this important administrative... .... This position is fully remote and offers the opportunity... ...contribution toward the medical insurance plan of your... ...changes. Investigate denied claims and assist in efforts to...Remote workClaimsFull timeWork at officeHome office
- ...Healthcare Utilization Review Specialist Join our team at Company and build a meaningful career in employee benefits solutions. As... ...customized, self-funded insurance programs. You'll review claims for medical necessity, verify authorizations, and collaborate across clinical...Remote workClaimsTemporary workSummer workFlexible hours
- ...Department Name: Utilization Mgmt Work Shift:... ...Management Care Reviewer, you will be an important... ...Team. This 100% remote role manages a... ...departments including Claims. The schedule for... ...determine the medical appropriateness of... ...cases to Medical Directors and presents them...Remote workClaimsFull timeMonday to FridayShift work
- ...classified as hybrid, onsite or remote. While the majority of our... ...to: Customer Service, Claims Processors, and Correspondence... ...Arizona. PURPOSE OF THE JOB The Utilization Review Supervisor coordinates the... ...as they relate to medical necessity reviews, authorizations...Remote workClaimsFull timeWork experience placement2 days per week1 day per week
- ...are required to address utilization review cases. Roles and... ...monitoring of cases involving medical decisions and quality... ..., reimbursement, and claim denials/appeals.... ...relationship with Medical Director on CM and UM cases.... ...Requirements This is a remote position. Our whole company...Remote workClaimsLive inFlexible hoursWeekday work
$30.64 - $45.8 per hour
...Description Job Description The Utilization Review Nurse gathers demographic... ...treatment, certifies the medical necessity and assigns an... ...and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS... ...concern to the appropriate claims staff/customer Collects...Remote workClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...first 25 applicants This is full-time remote, but candidates must reside in IL or TX... ...or managed care industry using medically accepted criteria to validate the medical... ...performing accurate and timely medical review of claims suspended for medical necessity, contract...Remote workClaimsFull timeContract work
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