Remote Medical Director: Appeals & Grievances (Pulmonology)
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Medical Director to lead appeals and grievances review for UnitedHealthcare. This role involves adjudicating cases across PPO, ASO, HMO, MAPD, and PDP products, applying clinical criteria and regulatory requirements. We value MD/DO board-certified leaders with 5+ years of clinical practice and 2+ years in quality management, strong telephonic communication, project management, data analysis, and presentation skills. #J-18808-Ljbffr UnitedHealth Group
- The Appeals and Grievances Medical Director at UnitedHealthcare oversees ongoing clinical review and adjudication of appeals and grievances for multiple... ...benefit interpretations. This role offers full remote work across the United States, with limited in-office requirements...Remote jobWork at office
- UnitedHealthcare is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals across health plans. This remote role offers the flexibility to work from anywhere in the U.S. You will perform case reviews, respond to regulatory...Remote job
- UnitedHealth Group is seeking an Appeals Medical Director (Pulmonology - Remote) to oversee ongoing clinical review and adjudication of appeals and grievances across multiple health plans. You will apply clinical criteria, coordinate with medical directors, and help shape...Remote job
$174.07k - $374.92k
...health care resources. **This is a remote based (work at home) based... ...US.** Responsibilities of this Medical Director role are related to Medicare Appeals: * Direct daily work on part C... ...Management - Medicare Complaints, Grievance & Appeals experience. * Health...Remote workHourly payFull timeTemporary workLocal areaWork from homeWeekend work$248.5k - $373k
...$248,500 - $373,000/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...Growing together. Work at home!The Appeals and Grievances Medical Director is responsible for ongoing clinical... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as...Remote workMinimum wageFull timeWork experience placementLocal areaWork from home$234.63k - $336.6k
...Your Role The Medical Management team ensures that Blue Shield of California (BSC) is on the cutting edge of... ...based health care system in California. The Medical Director, Utilization Management - Appeals and Grievances is a key member of BSC's Clinical Appeals and Grievance...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week- A prominent healthcare organization is seeking an Appeals and Grievances Medical Director to manage clinical reviews of appeals for various health plans. The role offers flexibility to work remotely. Qualified candidates should have an MD or DO, be board certified, and...Remote job
- UnitedHealth Group in Cypress, CA, is seeking an Appeals Medical Director for Radiation Oncology. This remote role involves ongoing clinical review and adjudication of appeals and grievances across multiple health plans, with the ability to work from anywhere in the U.S...Remote jobWork at office
- UnitedHealth Group's UnitedHealthcare seeks an Appeals and Grievances Medical Director to lead clinical review and adjudication of complex appeals across health plans. This remote role supports the U.S. healthcare system with a focus on policy interpretation, regulatory...Remote job
- UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication of appeals and grievances across multiple... ...and two years in Quality Management. The position is remote with collaboration across medical directors, regulatory...Remote job
$174.07k - $374.92k
For our client, we are seeking a Medical Director - Medicare Appeals to join the team of a leader in the Healthcare space. This remote leadership role will oversee Medicare appeals... ...management related to Medicare complaints, grievance, and appeals preferred Health plan...Remote workVisa sponsorshipWeekend work$223.8k - $313.1k
...Become a part of our caring community The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director works... .../ HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome office$236.5k
Position Purpose:Assist the Chief Medical Director to direct and coordinate the medical management... ...clinical teams, network providers, appeals team, medical and pharmacy consultants... ..., and a flexible approach to work with remote, hybrid, field or office work schedules...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract... ...experience Experience with prior authorizations and medical necessity reviews Grievance & Appeals experience...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work$180 per hour
...Job Description REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS \n \n $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension \n \n The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management...Remote workContract workWork at officeMonday to Friday- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
- Humana is seeking a Medical Director to review Medicare drug appeals (Part D & B) leveraging broad clinical expertise. The role involves case-by-case analysis of Medicare rules and Humana policies, plus collaboration with clinicians to optimize value-based care. Responsibilities...Remote job
- Humana Inc. is seeking a Medical Director to provide Medicare drug appeals review and medical necessity assessments. The role involves complex case analysis... ...with Medicare and Humana policies. You will work remotely with occasional travel to Humana offices for training...Remote job
$223.8k - $313.1k
Become a part of our caring community The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director works assignments... ...HIPAA information. Travel: While this is a remote position, occasional travel to Humana's...Remote workBi-weekly payFull timeTemporary workWork at officeLocal areaWork from homeHome office$236.5k
...clinical professional on our Medical Management/Health Services team... ...: Assist the Chief Medical Director to direct and coordinate the... ...clinical teams, network providers, appeals team, medical and pharmacy... ...approach to work with remote, hybrid, field or office work...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work- ...Managing and coordinating grievance and appeals processes, the full-time Grievance & Appeals Coordinator will review incoming cases, ensure compliance... ...collaborate with internal teams while working in a hybrid remote environment. Key responsibilities Manage and coordinate...Remote workFull timeWork at office
$122.9k - $188.02k
The Senior Manager, Clinical Appeals & Grievances provides strategic and operational leadership for the Clinical Appeals & Grievances function... ...offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs...Temporary workWork experience placementLocal area- ...full life cycle of member and provider appeals and grievance cases, the full-time Appeals and... ...ensure timely resolution while working remotely. Key responsibilities Research and analyze... .../appeals coordination Knowledge of medical terminology, benefit interpretation, and...Remote workFull timeWork at office
$31.5 per hour
Remote-Clinical Appeals Coordinator (RN) Remote-Clinical Appeals Coordinator (... ...final resolution. Evaluate medical records, benefit... .... Coordinate with Medical Directors, physician reviewers, and cross... ...Case Management Appeals and Grievances Managed Care Operations Strong...Remote workContract workWork at officeMonday to Friday- ...• Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related... ...appeals and grievance outcomes. • Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates...Remote workFull timeContract workWork at office
$223.8k - $313.1k
...part of our caring community The Medical Director uses their medical background, experience... ...timelines. This is a full-time, remote position with a standard schedule of... ...condition type. May also contribute to grievance and appeals reviews. Some medical directors may...Remote workFull timeTemporary workApprenticeshipLive inWork at officeWork from homeHome officeMonday to Friday- Job-ID32734260Reference26-01292Remote50% Remote Job Description: The Medical Director for respiratory will develop, implement, and lead the strategy and... ...., M.D., D.D.S. or Pharm. D.) Previous experience in pulmonology essential. Strong knowledge of Medical Affairs and...Remote work
- Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation... ...outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr HumanaRemote job
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHourly payFull time$280.84k - $393.18k
...President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical... ...activities including quality management, grievance and appeals, delegation oversight, and population... ...a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho...Remote workTemporary workLocal area
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