Remote Medicaid Medical Policy Director
Cotiviti USA, LLC
- Remote job
A healthcare solutions provider is seeking a Research Medical Director responsible for providing leadership in clinical and policy research. This role involves analyzing and developing medical policies as well as interpreting medical coding guidelines. Candidates should possess an MD or DO degree with a strong background in research and project management. This position offers a competitive salary and the possibility of remote work from the United States. #J-18808-Ljbffr Cotiviti
- ...Humana Inc. seeks a Medical Director to lead Medicaid care strategy and operational decisions across a multi-state cluster. Responsibilities include reviewing complex clinical cases, ensuring regulatory compliance, and coordinating with external physicians to discuss...Remote job
- ...CVS Health, including Aetna, seeks a Medical Director for a remote role supporting Medicaid members nationwide. Lead medical management decisions, partner with clinicians, and ensure timely, clinically sound reviews for diverse plans. Requirements include MD/DO with...Remote job
- ...CVS Health Corporation is seeking a Medical Director for Medicaid to join the centralized Medical Management team. This fully remote role supports Aetna Better Health of Virginia while providing regional coverage across the Northeast and other plans as needed. The...Remote job
- ...Humana Inc. is seeking a Medical Director to lead Medicaid care strategy and operations in a remote setup. The role involves evaluating moderately complex to complex clinical scenarios, reviewing medical records, and determining appropriate authorization within regulatory...Remote job
- ...Humana Inc. is seeking a Medical Director to lead Medicaid care strategy and operations, evaluating services, care levels, and sites of service within regulatory guidelines. You will review complex cases, assess medical records, and communicate decisions to internal...Remote job
- ...Humana Inc. is seeking a Medical Director focused on Medicaid care strategy and operations, with at least five years post-training clinical leadership... ...to advance value-based care across Medicaid populations. Remote, with travel as needed. #J-18808-Ljbffr Jobleads-USRemote job
- ...Humana Inc. seeks a Medical Director to lead Medicaid care strategy and operations. The role involves complex clinical determinations, regulatory compliance... ...across outpatient and inpatient settings. This remote position requires licensure in cluster states and travel...Remote job
- ...Humana Inc. seeks a Medical Director to lead Medicaid care strategy and operations. The role involves reviewing... ...external physicians. You’ll work remotely within a designated cluster, travel... ...compliance with regulatory and policy standards. The position requires a MD...Remote job
$174.07k - $374.92k
...Summary: This is a full-time, fully remote role. You can work from anywhere in the... ...impact on the health and well-being of Medicaid members across the country. Aetna... ...West Virginia. We are seeking a Medical Director to join our centralized Medical Management...Remote workHourly payFull timeTemporary workLocal areaWork from home- ...Humana Inc. is seeking a Medical Director to lead Medicaid care strategy and operations in a remote nationwide role. This senior physician will evaluate requested... ...within regulatory guidelines, leveraging CMS policies and NCQA standards. The role requires MD or DO...Remote job
$223.8k - $313.1k
## Medical Director Behavioral Health, MedicaidApplylocations: Remote Nationwide: Remote Louisiana: Remote Indianatime type: Full... ...clinical guidelines, state policies, CMS policies and determinations... ...reference sources* Learn Medicaid requirements and understand how...Remote workWeekly payFull timeTemporary workWeekend work$191.5k - $355.6k
...service corporation is seeking a Physician (M.D. or D.O) to handle medical policy responsibilities and perform medical reviews while interacting... ..., and 5 years of clinical experience. The position is 100% remote, with a competitive compensation package ranging from $191,500...Remote job- WPS Health Solutions seeks a Contractor Medical Director to research clinical evidence for LCDs, conduct medical reviews, and guide coverage... ...to practice in the U.S. This position offers hybrid or remote options for eligible states. #J-18808-Ljbffr WPS Health SolutionsRemote jobFor contractors
- ...is seeking a Physician Administrator for the Ohio Department of Medicaid to lead and manage clinical oversight of Medicaid services.... ...s Medicaid population. The successful candidate must possess a medical license and demonstrate skills in collaboration, innovation, and...
- ...a founding Compliance Manager to build and scale a robust compliance function within a fast-moving healthcare company focused on Medicaid/Medicare beneficiaries. You will partner with engineering, operations, clinical, and growth teams to design compliant processes that...Remote job
- ...Humana Inc is seeking a Medical Director for Behavioral Health to oversee complex behavioral health care strategies. This remote position requires a Doctor of Medicine or Osteopathy and board certification in Psychiatry, along with extensive experience in clinical services...Remote job
- ***Remote and must live in or relocating to Idaho***JOB DESCRIPTION Job SummaryLeads and... ...adequacy for Medicare, Marketplace, and Medicaid services. • In conjunction with network... ...initiatives to positively influence the medical cost ratio (MCR) in each contracted region...Remote workContract workLive inWork at officeRelocation
$174.07k - $374.92k
...Louisiana & West Virginia). **This is a remote based (work at home) based anywhere... ...US.** Responsibilities of this Medical Director role are related to Medicaid Appeals You will support the... ...Previous experience in Medicaid Policy and the use of Dynamo Appeals and Grievances...Remote workHourly payFull timeTemporary workLocal areaWork from home$141.6k - $212.4k
..., supplemental health, medical stop-loss insurance, and... ...are designed for Medicaid and CHIP, Medicare Advantage... ...The opportunity: The Director, Health Plan Dental Solutions... ...independently in a remote environment while... ...employee California Privacy Policy and Notice.We do not require...Remote workFull timeWork at officeLocal areaFlexible hours$72k - $130k
Transformcap is seeking an Associate Director/Director of Medicaid Entitlement & Coverage Strategy to lead... ...role requires expertise in Medicaid policy and experience in healthcare... ...The position offers the flexibility of remote work, although candidates from certain...Remote job$238k - $357.5k
...Optum is hiring Medical Directors in remote, full-time roles. These positions are ideal for Ear, Nose & Throat physicians who want to apply their clinical expertise in a strategic, administrative setting that improves care outcomes. Your impact includes coverage reviews...Remote workFull time- ...Pennsylvania (onsite/hybrid/remote with periodic in state... ...) Reports to: Chief Medical Officer Department:... ...regulatory performance for our Medicaid line of business across... ..., including medical policy, clinical guidelines,... ...leadership role (Medical Director or Deputy) specific to...Remote workFull timeContract workPart timeRelocation
- ...Medical Director, Global Medical Strategy Otsuka is a leader and innovator in the therapeutic area, with a strong portfolio of development... ...their work activities in compliance with all Otsuka internal policies and SOPs and with all applicable regional and federal...Remote work
$86.3k - $118.7k
...Digital Space LLC is hiring a Product Manager-Medicaid & Duals to oversee insurance products... ...of related experience. The position is remote, accommodates EST/CST hours, and offers a... ...plus bonus eligibility. Benefits include medical, dental, vision, and 401(k) plans. #J-18...Remote work$1,020 per month
...INITIATIVE SENIOR DIRECTOR, HEALTH PLANS The Context... ...dollars spent on medical care alone. The amount... ...institutions to redesign their policies and invest... ...North Carolina to use Medicaid dollars to provide patients... ...role and is fully remote within the US. THI expects...Remote workFull timeTemporary workInterim roleWork at officeFlexible hoursShift workWeekend workAfternoon shift$120k - $135k
...#LifeatRealChem.Job Summary:Real Chemistry is looking for an Associate Director, Medical Strategy tojoin our growing team!Our Associate Directors... ...New York City, Boston, Chicago, Carmel, or San Francisco—or remotely within the US, depending on team and business needs.What you...Remote workWork at officeLocal area2 days per week$122k - $203k
..., with an emphasis on Medicaid programs and the responsible... ....The Associate Director will oversee cross-functional... ...that aligns to agency policies and applicable... ...workplace.Benefits include:Medical, Rx, Dental & Vision... ...SummaryLocation: US - Remote (Any location); US -...Remote workFull timeFlexible hours- ...Medicaid Project Manager-RHTP Job Description Key Responsibilities Lead the project management and operational implementation... ...reports. Minimum Requirements Master's degree in Public Policy, Public Administration, Public Health, Healthcare Administration...Remote workTemporary work
$150k - $188k
...care, including hospitals, health systems, medical groups, academic medical centers,... ...affiliate network development. Assistance with Medicaid managed care program participation. Patient... ...a client engagement. We will consider remote hires, but prefer an in‑office presence through...Remote workPermanent employmentFull timeContract workWork at office2 days per week$105k - $125k
Overview The Medical Policy Release Manager is responsible for managing the medical policiesreleases... ...requirements (e.g., Medicare, Medicaid, AMA). Coordination & Communication: Act... ...if a qualified candidate is selected. #LI-Remote#LI-MV1#senior #J-18808-Ljbffr CotivitiRemote workTemporary workWork at officeImmediate startWork from homeWeekend work
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