Remote Medical Director, Claims & Utilization Review
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- Remote job
Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and utilization management. You will collaborate with leadership to maintain processes for benefit coverage, quality improvement, and cost effectiveness for members. The role emphasizes clinical expertise, communication with network and non-network physicians, and leadership in clinical rounds and decision-making within a multidisciplinary team. #J-18808-Ljbffr Tnafp
- Optum is seeking a Medical Director to provide physician support for Enterprise Clinical Services, overseeing clinical coverage determinations and utilization management. You will collaborate with leadership to maintain processes for benefit coverage, quality improvement...Remote jobClaims
$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$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... ...employees working remotely will be required to adhere...Remote workClaimsMinimum wageFull timeWork experience placementLocal area$223.8k - $313.1k
...of 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... ...information. Travel: While this is a remote position, occasional travel...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$248.5k - $373k
...Medical Director Optum is a global organization that delivers care,... ...clinical coverage and medical claims reviews. Our role is to empower... ...clinical knowledge in various utilization management activities with... ...enjoy the flexibility to work remotely from anywhere within the U....Remote jobClaimsMinimum wageFull timeWork experience placementLocal area- ...CorroHealth is seeking a Medical Director, Concurrent Review, to evaluate hospitalizations nationwide. The... ...provide expert recommendations. This remote position offers a predictable... ...and a path to expand knowledge in Utilization Review. Ideal candidates hold an MD...Remote work
- ...Medical Director, Utilization Management The Medical Management team ensures that Blue Shield is on... ...deliver and collaborate on clinical review activities, which includes management... ...retrospective utilization review, and provider claims dispute reviews. In addition, the...ClaimsFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- Integra Partners is seeking a Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a high-volume UM environment. The... ...or PM&R, and experience in utilization management. Remote work during standard business hours is supported, with opportunities...Remote job
- 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
- Kelsey-Seybold Clinic, part of the Optum family, is hiring a Utilization Review LVN nurse in Houston area. The role involves data entry, eligibility verification, and coordinating with insurers for pre-certification. Requirements include TX LVN license and UR experience...Remote jobClaimsHourly pay
$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- ...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 jobClaimsFor contractorsMonday to FridayFlexible hours
- ...BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical... ...role documents decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours 8:00 AM...Remote jobClaimsFull time
- 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
- ...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 office
- UnitedHealth Group, through Optum, seeks a Medical Director to lead the Focus Claims Review program and guide claim review services, including provider telephonic... ...compliance and high-quality reviews. The role offers remote work across the United States, with a Monday-Friday...Remote jobClaimsMonday to Friday
- ...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
$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers demographic and... ...treatment, certifies the medical necessity and assigns an appropriate... ...and of CorVel. This is a remote position.Essential Functions... ...concern to the appropriate claims staff/customerCollects data...Remote workClaimsFull timeWork 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
- ...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...Remote workClaimsLive inFlexible hoursWeekday work
- ...Utilization Review And Management (UM) Component Program The utilization... ...MedHealth contracted facilities are medically necessary, clinically... ...and documentation of claims along the process chain. 2... ...This is an in-office, no remote work capability position...Remote workClaimsFull timeWork at office
$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$35 - $43 per hour
...life-changing decisions, one review at a time? Why This Role... ...waiting on an answer to the Medical Director who depends on a clean, well... ...ED, or similar setting) ~ Utilization review/utilization... ...and HCPCS coding and medical claims Ability to interpret medical...Remote workClaimsHourly payImmediate startMonday to FridayFlexible hours- ...Utilization Review Supervisor Awarded a Healthiest Employer, Blue Cross... ...classified as hybrid, onsite or remote. While the majority of our... ...to: Customer Service, Claims Processors, and Correspondence... ...department as they relate to medical necessity reviews, authorizations...Remote workClaimsFull time2 days per week1 day per week
- The Utilization Review Nurse gathers demographic and clinical information on... ...treatment, certifies the medical necessity and assigns an appropriate... ...and of CorVel. This is a remote position. ESSENTIAL... ...concern to the appropriate claims staff/customer Collects data...Remote workClaimsMinimum wageWork at officeLocal areaFlexible hours
- ...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
$64k
...department, ensuring that medical necessity is clearly documented... ...care. Reporting to the Director of Utilization Review with a dotted-line... ...modifier guidance to ensure clean claim submission. Participate... ...working independently in a remote environment while...Remote workClaimsFull timeContract workPart timeWork at officeShift work- ...integrating, and monitoring the utilization of behavioral health (BH)... ...appropriate cases to the Medical Director for review. Refer to and work closely... ...pricing, coding, researching claims to ensure accurate... ...There may be opportunity for remote work within all jobs posted...Remote workClaimsContract workWork at office
$41 per hour
...Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State of IL This position is a contract for... ...responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation...Remote workClaimsContract work- 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 jobClaimsFull time
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