Remote Health Plan Utilization Management Medical Director
Medix
Medix is seeking Board Certified physicians with Health Plan Utilization Management experience for a fully remote role. You will perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations, review prior authorizations, appeals, and grievances, and conduct peer-to-peer discussions with treating providers. You will apply InterQual and MCG guidelines, collaborate with dedicated nurses and care managers, and work within a technology-enabled workflow #J-18808-Ljbffr
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Health Plan Utilization Management Medical Director in New York, NY vacancy
$224k - $364k
...United States FL, United States (Remote) Job Description The Medical Director will work closely with the team to perform all types of utilization management (UM) reviews, including but not... ...(Peer to Peer) • Apply health plan review hierarchy to member contracts...Remote workHealth InsuranceTemporary workPart timeWork experience placementInternshipSeasonal workFlorida Blue Group
Florida13 hours ago- ...Lead UM Medical Directors in making timely, evidence-based medical... ...: Manage a team, review complex cases, and chair the Utilization Management Committee.... ...parental leave. Clover Health Clover Health provides healthcare plans for America's seniors,...Remote workHealth InsuranceFlexible hours
Clover Health
United States3 days ago $332.3k - $377.4k
...Job Description Select Health, a regional health plan with over a million members serving... ..., is seeking an experienced Medical Director with expertise in Utilization Management (UM), Care Management (CM)... ...expectations. If applying for a remote or hybrid role, this includes...Remote workHealth InsuranceHourly payLocal areaRelocation packageIntermountain Healthcare
Murray, UT2 days ago- ...Centene Corp. seeks a Medical Director (PRN) to assist the CMO in directing physician utilization management for the health plan units. The role is roughly 20 hours per week with Thursdays and Fridays as the highest priority. Board-certified MD/DO with Indiana license...Remote workHealth InsurancePart timeRelief
Centene Corporation
United States1 day ago - Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length:... ...determinations based on member benefit plans, medical policies, clinical... ...SNF, IRF, LTACH, and home health. Evaluate the appropriateness...Remote workHealth InsuranceHourly payContract workImmediate start
$248.5k - $373k
...Job Area: Medical & Clinical Operations... ...physician to join our Utilization Management team. Optum is a... ...The Medical Director for Utilization Management... ...of advancing the health of your community... ...to work remotely * from anywhere within... ...of the health plan members and commensurate...Remote workHealth InsuranceMinimum wageFull timeWork experience placementWork at officeLocal areaWork from homeUnitedHealth Group
United States3 days ago- ...Support utilization management processes and review authorizations for medical necessity. Perform peer-to-peer discussions with providers and... ...About Clover: Data-driven health insurance focused on seniors. Remote-first, mission-driven, and collaborative...Remote workHealth Insurance
Clover Health
United States3 days ago $213.1k - $308.3k
...SCAN is a nonprofit health organization... ...care for the most medically and socially complex... ...serve. The Job The Utilization Management (UM) Physician Medical Director provides physician... ...based guidelines, plan policy, standard... ...Work Mode - Mostly Remote: Employees who reside...Remote workHealth InsuranceFor contractorsWork at officeLocal areaRelocation$75.3k - $135.4k
...Supervises the behavioral health (BH) utilization review clinicians to... ...of BH utilization management team. Key Details:... ...Centene is seeking a remote Supervisor, Behavioral... ...represent the team on health plan calls, and... ...Understanding of medical necessity criteria for...Remote workHealth InsuranceFull timePart timeWork at officeFlexible hours$240k
...clinically driven, tech-enabled utilization management company offering expert... ...opportunities An award-winning remote work environment Position Summary Our Medical Director, also known as a Physician Advisor... ..., and security of sensitive health information. California...Remote workHealth InsuranceFull timeTemporary workWork at officeWork from homeShift workRotating shiftWeekend workMrioa
Nashville, TN3 days ago- ...Centene Corp. is seeking a remote Supervisor of Behavioral Health Utilization Management to lead a PIC ABA team of certified BCBAs. The role involves guiding... ...review, and collaborating with providers and health plan partners to support sound clinical decisions. The...Remote workHealth Insurance
Centene Corporation
United States4 days ago $320k - $340k
...partner company, who manages all applications and... ...is looking for a Lead Medical Director, Utilization Management based in the... ..., and outcomes. This remote-first role combines... ...holidays. Mental health resources and... ...Employee Stock Purchase Plan (ESPP) with discounted...Remote workHealth InsuranceFull timeWork at officeFlexible hours$320k - $340k
...At Clover Health, we are committed to providing... ...healthcare plans for America’s seniors... ...it most. The Utilization Management team supports... ..., evidence-based medical necessity decisions... ...The Lead Medical Director, Utilization Management... ..., we embrace a remote-first culture...Remote workHealth InsuranceFull timeWork experience placementWork at officeLocal areaFlexible hours- ...Primary Work Location : Remote (Oregon Headquarters)... .... Department: Health Plan Operations FLSA... ...Salaried) Division: Utilization Management Physical Strength:... ...Reports To: Nursing Director - RN Work Location Type... ...with the YCCO Chief Medical Officer (CMO) and/or...Remote workHealth InsuranceContract workFor contractorsCasual workWork at officeLocal areaFlexible hours
Yamhill Community Care
Mcminnville, OR2 days ago $28.28 - $47.13 per hour
...Name: Behavioral Health Work Shift: Day... .... At Banner Plans & Networks, we’re... ...Behavioral Health Utilization Care Manager , you will be assigned... ...reviews for medical necessity. You will... ...will be entirely remote . This position does... ...with medical directors. Within the scope...Remote workHealth InsuranceWork experience placementWork at officeMonday to FridayShift work- ...Brighton Health Plan Solutions seeks a Medical Director to perform utilization review and medical necessity determinations for BHPS-administered self-funded commercial... ...decisions that guide member care. This remote role requires board-certified physicians with UR...Remote workHealth Insurance
Brighton Health Plan Solutions
United States13 hours ago - ...Job Description\n Utilization Management Medical Director Oncology\n\n\n \n \n Work Location: REMOTE (work from home)\n \n \n The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with...Remote workWork from home
Starling Oncology
Cerritos, CA4 days ago $215.01k - $408.49k
...coordinate the physician component of the utilization management functions for the health plan business units. Key Details:... ...highest priority. Provides medical leadership for utilization... ...a flexible approach to work with remote, hybrid, field or office work schedules...Remote workHealth InsuranceHourly payFull timePart timeReliefWork at officeFlexible hours$260k - $275k
...Medical Director – Health Plan – RemoteSalary Range: $260,000 – $275,000 per year Location: New York, NY Remote / Onsite: Remote – Monday through Friday, Business HoursPosition... ...appropriate healthcare utilization through Utilization Management, medical necessity and...Remote workHealth InsuranceContract workMonday to FridayRCM Health Care Services
New York, NY2 days ago$240k - $250k
...Medical Director Utilization Management We are looking for physicians who have expertise... ...Medical Director for Cohere Health, this is a critical role... ...perspectives. This is a remote-first role that may require... .... 401K retirement plan with company match; flexible...Remote workHealth InsuranceFlexible hoursVenturefizz Product Management Community
United States3 days ago- ...GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate...Remote work
GuideWell
United States3 days ago - ...Humana Inc is seeking a Medical Director to lead inpatient medical necessity reviews and utilization management with a focus on quality and physician collaboration. The role... ...and support Humana’s care standards. This remote position requires MD or DO, board...Remote work
Humana
United States13 hours ago - ...Medical Director (BH, UM) - Honolulu, HIThis is a remote position requiring active Hawaii licensure.... ...clinical vision for the health plan(s) for all lines of... ...multiple health plans managed by the Clinical Center... ...Develops and implements a Utilization Management program and...Remote workHealth InsuranceFull timeContract workPart timeInternshipImmediate startFlexible hours
Msccn
Honolulu, HI3 days ago - ...Medix is seeking Board Certified physicians with Health Plan Utilization Management experience for a fully remote role. You will perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations, review prior authorizations,...Remote workHealth Insurance
Medix
United States2 days ago - ...HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage...Remote work
HJSRLLC
Eagan, MN3 days ago $50 - $170 per hour
- /Healthcare - Medical Director# Healthcare - Medical Director... ...a 1099 Behavioral Health Physician (MD/DO) to provide non-clinical utilization management services for behavioral... ...; the position is remote, requires at least 20... ...Managed care or health plan experienceFor job...Remote workHealth InsuranceHourly pay$174.07k - $374.92k
...building a world of health around every... .... This is a remote based (work... ...and current US medical license without... ...In the Medical Director role you will provide... ...'s medical management programs to address... ...on overseeing utilization review /... ...with a Health Plan/Payor. Education...Remote workHealth InsuranceHourly payFull timeTemporary workLocal areaWork from home- ...Clover Health is seeking a Lead Medical Director, Utilization Management, to guide medical necessity decisions for outpatient referrals and inpatient admissions. You... ..., and drive quality improvements, all within a remote-first framework supporting US operations. #J-18...Remote work
Clover Health
United States4 days ago $232.48k - $290.6k
...Overview Acentra Health exists to empower... ...that can be utilized to improve processes... ...(part time) Medical Director to join our growing... ...This position is remote within California... ...assessments, intervention plans, and training... ...of care-management services. Support...Remote workHealth InsuranceContract workPart timeLocal areaFlexible hoursAcentra
United States4 days ago- ...Community First Health Plans (CFHP) seeks a Medical Director for Population Health Management in Texas. You will lead utilization management across multiple product lines and ensure compliant, timely decisions aligning with CFHP’s mission and Triple Aim Plus objectives...Health Insurance
University-Health-3
San Antonio, TX3 days ago
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