Remote Medical Director, Claims & Utilization Review
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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
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Medical Director, Claims & Utilization Review in Atlanta, GA vacancy
$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$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 hoursVenturefizz Product Management Community
United States1 day ago$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 workHumana
Oklahoma City, OK2 days ago- Optum in the United States is seeking a Medical Director to provide physician support to... ...emphasizes applying clinical knowledge to utilization management and communicating with network... ...collaborate with a multidisciplinary team, review policies, and ensure cost-effective,...Remote jobClaims
$172.36k - $258.55k
Physician Advisor, Utilization Management (CA... ...License Required)remote type: Fully Remotelocations... ...works with Senior Medical Officers, Regional... ...complete clinical reviews for medical... ...Reviews the entire claim denial process, including... ...to Quality Director. 10. Works with Extensivists...Remote jobClaims$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$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- ...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
CURAtive
United States1 day ago - ...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
Dane Street
United States4 days ago - 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 job
- 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
- Humana Inc. is seeking a Medical Director to lead inpatient medical necessity reviews, applying national guidelines, CMS regulations, Humana policies, and clinical... ...will analyze complex hospital cases, craft clear utilization determinations, and communicate outcomes to...Remote jobMonday to Friday
$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services... ...planning and utilization review. Reviews admissions and... ...concurrent and retrospective medical necessity and/or... ...precertification, reimbursement and claim denials/appeals....Remote jobClaims$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 areaIntegra Partners
Troy, MI12 days ago- ...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
Nrg-Mgmt-LLC
Boca Raton, FL2 days ago - ...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
$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 workClaimsMinimum wageFull timeWork at officeLocal areaFlexible hoursCorVel
Rancho Cucamonga, CA3 days ago$2,210 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 timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hoursHines
Freeport, IL4 days ago- ...health outcomes through care, technology, and data. The Medical Director will provide leadership for the claims review program, including provider discussions, appeals and in coding development. You’ll work remotely from anywhere in the U.S. with a flexible schedule, a...Remote jobClaimsFlexible hours
- 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
New Horizons
United States22 hours ago $35 - $40 per hour
...solutions, payment integrity, claims cost containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct... ...procedures, Medicare Part B medications, LTSS, and Home Health.... ...weekends. Location: Fully remote work at home role. Secure,...Remote workClaimsHourly payTemporary workMonday to FridayFlexible hoursWeekend workSagility LLC
New York, NY2 days ago$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 hoursSedgwick
United States22 hours ago- ...Most of the training will be remote however you will be required... ...required to start onsite A Utilization Review (UR) Nurse is a registered nurse... .... They evaluate patient medical records to ensure treatments... ...(retrospective) to prevent claim denials and ensure accurate...Remote workClaimsWork experience placementFlexible hoursShift workWeekend work
- 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
- Optum, a global health services company, seeks a Medical Director to lead the Focus Claims Review team. You will oversee medical claim review quality, coordinate... ...for medical programs and services. You’ll work remotely from anywhere in the U.S. Responsibilities include surgical...Remote jobClaims
$60k - $83.2k
...Requirements The Clinical Review Coordinator conducts... ...process. The role is remote work, but you must... ...standards of care, and utilization review criteria applicable... ...providers, and other medical personnel. Protects... ...performing pre- and post-pay claims reviews, and...Remote workClaimsFull timeContract workFor contractorsWork at officeShift workGrabJobs
Phoenix, AZ4 days ago
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