Remote Clinical Review Supervisor (Utilization & Quality)
Council of State and Territorial Epidemiologists
- Remote job
The Council of State and Territorial Epidemiologists is looking for a Clinical Review Supervisor to oversee clinical staff conducting utilization reviews. This fully remote position requires strong leadership in a healthcare context and a proactive approach to quality management. Key responsibilities include supervising utilization management, conducting audits, and supporting staff development. Qualifications require an active RN license, a minimum of 5 years of clinical experience, and utilization review experience. Outstanding benefits include medical insurance, paid time off, and a retirement savings plan. #J-18808-Ljbffr Council of State and Territorial Epidemiologists
- ...Epidemiologists is seeking a Clinical Review Supervisor to provide operational... ...clinical staff conducting utilization reviews and specialty review activities. This fully remote position requires a strong... ...skills. This role supports quality management initiatives aimed...Remote job
- ...has engaged in health care quality consulting and quality... ...patient outcomes. Our talented remote workforce spans the... ...and based in Alabama. The Supervisor, Clinical Review plays a critical role in providing... ...staff who conduct utilization review and/or specialty reviews...Remote workContract work
$250k
...The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related... ...of observed trends, potential quality concerns, or opportunities to... ...Additional Expectations: Full-time remote role requiring consistent...Remote workFull timeTemporary workLocal area- ...to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical... ...skills, as well as 5+ years of clinical experience post-residency. Ideal candidates will have a dedication to quality care and enjoy working in a structured,...Remote job
- ...Medical Director to conduct inpatient medical necessity reviews while collaborating with healthcare providers. This... ...analytical skills. Responsibilities include performing clinical reviews, providing utilization management determinations, and ensuring compliance with...Remote jobMonday to Friday
- ...for overseeing and performing utilization reviews, prior authorizations, and... ...Director will serve as a key clinical expert, ensuring appropriate... ...peer discussions. This is a remote position requiring a "roll... ...protocols. Participate in quality improvement initiatives, audits...Remote workFull timeFlexible hours
$78.7k - $134.9k
...connected care, where coordinated, quality service is the norm and every member feels valued. The Supervisor, Quality Reviewers is responsible for leading day-to-day clinical review and medical record... ...record retrieval work including remote electronic health record (EHR)...Remote workWork experience placementWork at office3 days per week- COMAGINE HEALTH in Nevada seeks a Supervisor, Clinical Review to supervise clinical staff conducting utilization reviews. Ideal candidates will have an active RN licensure... ...communication skills are crucial. The position offers a remote work option along with comprehensive benefits,...Remote work
$223.8k - $313.1k
A leading U.S. healthcare company seeks a Medical Director to enhance inpatient care quality. This role involves performing expert clinical reviews, analyzing hospital cases for necessity, and collaborating in a structured team environment. Candidates should have an MD...Remote job- ...healthcare provider is seeking a Medical Director to review health claims and ensure compliance with clinical standards. The ideal candidate will have a strong... ...is based in Sacramento, CA, with standard hours and some remote work flexibility. #J-18808-Ljbffr Humana IncRemote job
- ...to guide medical management and quality improvement initiatives for its Health... .... The role involves directing utilization management and collaborating with clinical teams to enhance care quality.... ...package including health insurance and remote work options. #J-18808-Ljbffr...Remote jobFull time
- A leading insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not require prior utilization review experience and is perfect for skilled nurses looking to transition...Remote jobFull timeWork at officeWork from home
- ...Clinical Quality Assurance Supervisor (RN, LPN, LVN) - 100% Remote Schedule: Monday-Friday, 8:30 AM-5:00 PM CT (with occasional... ...effective and efficient utilization of all clinical resources and... ...independent medical examinations, peer reviews, bill reviews, Medicare...Remote workLocal areaWork from homeMonday to FridayWeekday work
- Industrial Asset Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a clinical review capacity. This work-from-home position offers flexible scheduling...Remote jobWork from homeFlexible hours
- ...according to policy. Assists non-clinical staff in performance of administrative reviews Performing comprehensive... ...pre-certifications and appeals, utilizing medical appropriateness criteria... ...we serve members. BCBST is a remote-first organization with many employees...Remote workContract workCasual workWork at officeWork from homeRelocation package
- A healthcare organization is seeking a Clinical Review Supervisor based in Alabama. The role requires an active RN license and involves supervising clinical staff for utilization reviews while ensuring compliance with healthcare standards. Candidates should have at least...
- ...outpatient behavioral health utilization management clinicians:... ...role serves as a key clinical decision-maker,... ...with a focus on clinical quality and compliance.... ...complexity requires further review, ensuring decisions... ...Demands: • Primarily remote role with periodic travel...Remote workWork at office
- ...operational areas of the Utilization Management (UM)... ...concurrent, and retrospective reviews. As a Medical Director... ..., procedures, and clinical guidelines aligned with... .... They partner with Quality Improvement teams to analyze... ...Work Arrangement Remote role Monday through...Remote workLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift
- ...care dollars while ensuring quality care through effective programs... ...~ Work-life balance. ~ Remote/hybrid setting (once trained... ...Description: This individual will utilize clinical knowledge and communication... ...decision to a second level reviewer. This individual interfaces...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
- ...DESCRIPTION Medical Director - Utilization Management (Payer Side Experience Required)- (Remote) Duration: 30 Weeks... ...for conducting medical necessity reviews, appeals, and escalated case... ...Prepare clear and concise clinical rationales for provider and member...Remote workFull timeContract workPart timePrivate practiceMonday to FridayFlexible hours
- ...The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete... ...equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast-paced...Remote workFull timeTemporary work
- ...and oversees the team focusing on utilization management inpatient medical necessity reviews and transitions of care (TOC)... ...operational efficiency, and high-quality member outcomes. The role plays... ...part in driving performance across clinical quality, timeliness, and care...Remote workFull timeTemporary workPart timeWork experience placementWork at officeTrial periodFlexible hours
- ...Director National OP Medicare to utilize clinical expertise and medical... ...involves complex clinical case reviews and required knowledge of... ...and internal teams to ensure quality care and effective resource... ...utilization. Humana offers a remote work model with competitive...Remote work
$122.44k
...administration of the Medical Review and Prior... ...standards, workload issues, quality control, training and... ...Location: This is a remote position. Typical work... ...program management, utilization/case management, or... ...coordination with other clinical staff and underwriting...Remote workContract workFor contractorsWork experience placementWork at officeLocal areaMonday to Friday- ...Medical Director Utilization Management Location: Remote Preference EST or nearby Pittsburgh PA, NY, WV Duration: 6+ Months Contract... ...accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically using Medical...Remote workContract workPrivate practice
- ...Description Job Description: Clinical Supervisor, UM Denial Compliance... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)... ...essential in ensuring a high-quality, efficient, and compliant denial... ...managing daily tasks, performance reviews, and disciplinary actions....Remote workPermanent employmentTemporary work
$234.63k - $336.6k
...BSC) is on the cutting edge of utilization management reimagined to... ...Commercial Prior Authorization Review will report to the Senior Medical... ...deliver and collaborate on clinical review activities, which... ...clinical staff in maintaining high quality clinical reviews and work...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week$223.8k - $313.1k
...on medical background and reviews health claims. The... ...dedicated to advancing the quality of inpatient care through clinical expertise and thoughtful... ...or those experienced in Utilization Review are encouraged to... ...Travel: While this is a remote position, occasional travel...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$211.2k - $277.2k
...Physician Reviewer - Utilization Management You will determine the medical... ...pharmacy services by reviewing clinical information and applying... ...Work Location: This is a remote position, open to candidates... ...that meet Oscar's stringent quality parameters. Provide...Remote workFull timeLocal areaWork from homeHome officeWeekend work$238k - $357.5k
...Director Oncology will provide utilization review determinations and support... ...management teams to achieve optimal clinical outcomes. You'll enjoy the flexibility to work remotely from anywhere within the U.S.... ...to close clinical quality / service gaps, and care plan...Remote jobFull timeWork experience placement
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