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
- UnitedHealthcare, a UnitedHealth Group company, is seeking a Medical Director to lead appeals and grievances clinical review for multiple health plans. The role... ...in clinical practice and quality management. Remote work options within the U.S. are available. #J-18808...Remote job
$248.5k - $373k
...$248,500 - $373,000/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ...week.Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...Remote workMinimum wageFull timeWork experience placementWork at officeLocal area- 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's UnitedHealthcare division seeks an Appeals and Grievances Medical Director to lead clinical reviews and adjudicate cases across multiple health plans. This remote position offers high impact work, cross-functional collaboration, and ongoing professional...Remote jobFlexible hours
$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$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This...Remote workContract workWork at officeMonday to Friday- Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote jobWork from home
- ...Healthfirst is seeking a Grievance Specialist to join its Appeals & Grievances team in a fully remote position. You will manage and resolve member complaints across Medicare, Medicaid, and other Healthfirst programs, coordinating with internal teams and external partners...Remote work
- ...Workday is seeking a Grievance & Appeal Specialist to address appeals within required timeframes and ensure contractual obligations are met.... ...Procedures to ensure compliance with regulatory standards. This remote position requires strong communication, confidentiality, and...Remote work
$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- ...Insurance services, seeks an accomplished Medical Appeals Coordinator Position: Medical Appeals... ...!!! Pay rate: $24/hr on W2 Note: REMOTE role with possibility The schedule for... ...non-complex pre-service and post service grievances and appeals requests from customer...Remote workTemporary workLocal areaFlexible hours3 days per week1 day per week
$103.4k - $149.43k
The Appeals & Grievances (A\&G) Weekend Inventory Manager is responsible for managing and monitoring appeal inventory for a team of A\&G Clinical... ...through the weekend Communicate and elevate cases to Medical Peer reviewers Maintain delegated vendor relationships and...Full timeTemporary workWork experience placementLocal areaWeekend work$191.5k - $355.6k
...Job SummaryThis position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts... ...internal medicine specialties preferred but nt required This is a remote work from home role #LI-MG1Are you being referred to one of our...Remote workFull timeWork at officeWork from home$103.4k - $149.43k
The Manager, Clinical Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Clinical Appeals... ...Provides guidance in the preparation of case preparation for Medical Director Review ensuring that all pertinent information (i.e. case...Contract workTemporary workWork experience placementLocal areaFlexible hours- UnitedHealth Group seeks a physician leader to review appeals and guide clinical policy across health plans. The role requires an MD/DO... ...communication and project management skills are essential. Remote work is available nationwide in the U.S.; some in-office requirements...Remote jobWork at office
- ...Managing the resolution process for medical and pharmacy member appeals and grievances, the full-time remote Appeals and Grievance Specialist will ensure compliance with regulatory requirements and accreditation standards while coordinating with internal and external...Remote workFull time
- 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
$59 - $60 per hour
WE’RE HIRING: REMOTE REGISTERED NURSE (RN) 100% REMOTE | MONDAY-FRIDAY | $59-$60/HR We are looking for experienced Registered Nurses... ...Management experience Prior Authorization experience Grievance & Appeals experience preferred, but not required #J-18808-Ljbffr PhaxisRemote workMonday to Friday$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- 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 job
- Point32Health is seeking an Appeals and Grievance Coordinator to support the A&G Analyst by handling mail, organizing cases, and ensuring timely processing in accordance with state and federal regulations. The role requires 1-2 years in health care customer service and...Remote job
- ...seeking an entry-level analyst in the Enterprise Grievance & Appeals Department to review and process non-... ...clear determinations, and coordinate with medical staff as needed, while adhering to URAC and NCQA standards. Remote work is allowed with some onsite requirements...Remote jobContract work
- ## Medical DirectorApply: Fully Remote: US - Remote: Full time: Posted Today: R35494At Allstate, great... ...programs. The Medical Director is a highly experienced physician... ...clinical decision-making, including appeals, rescissions, grievance reviews, and Department of Insurance...Remote workFull timeContract workWork at officeWork from homeWork visa
- ...About The Role The Medical Director performs utilization review and medical... ...assignment. *This is a Remote Role Primary... ...rationale that is defensible on appeal, external review, and audit.... ...input on member and provider grievances and reviews complaint resolution...Remote workWork at officeLocal areaFlexible hours
- Medasource is hiring a G&A Coordinator to support a high-volume Grievances & Appeals team in the United States (Arizona residents only). This fully remote role focuses on member and provider appeals, grievances, and claim disputes, requiring 3-4+ years of relevant experience...Remote job
- ...Role - Medical Director Client - Highmark (working with preferred vendor) Location - Remote Employment - Contract to hire Rate - $120... ...determination of cases, review of appeals and grievances, and other reviews as assigned. Compose...Remote workContract workPart timePrivate practice
- ...Health is seeking an entry level Analyst in the Enterprise Grievance & Appeals Department in California. The role focuses on reviewing non-... ...composing clear determinations, and coordinating with nursing/medical staff when needed. The ideal candidate has a HS diploma or...Remote job
$123.37k - $161.93k
...'re Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team. Oscar is the first... .... Work Location: This is a remote position, open to candidates who reside... ...are eligible for benefits including: medical, dental, and vision benefits, 11 paid...Remote workFull timeWork from homeHome office$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 jobHourly payFull time$22.49 per hour
As a Grievance and Appeals Coordinator, you will spend your day acknowledging and resolving member... ...operations. Participate actively in a remote, collaborative environment (Note:... ...comprehensive benefits package, including: medical, prescription, dental, vision, AD&D,...Remote workHourly payPermanent employmentTemporary workWork experience placementShift work
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