Remote Appeals Medical Director - Lead Clinical Decisions
Texas Health Institute
- Remote job
UnitedHealthcare is hiring a Medical Director for Appeals and Grievances, responsible for clinical review and adjudication across multiple health plans. The role supports remote work from anywhere in the U.S. and requires collaboration with regional and plan medical directors, as well as regulatory bodies. The position emphasizes clinical leadership, policy interpretation, and cross-functional teamwork to improve access and outcomes in a complex health system. #J-18808-Ljbffr Texas Health Institute
- UnitedHealthcare is hiring a Medical Director for Appeals and Grievances, responsible for clinical review and adjudication across multiple health plans. The role supports remote work from anywhere in the U.S. and requires collaboration with regional and plan medical directors...Remote job
$248.5k - $373k
...- $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...the flexibility to work remotely * from anywhere within... ...Responsibilities:The Appeals and Grievances Medical Director is responsible for... ...directors regarding appeals decision rationales, and benefit...Remote workMinimum wageWork experience placementLocal areaWork from home- ...Growing together Work at home! The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of... ...the flexibility to work remotely from anywhere within the U.S.... ...directors regarding appeals decision rationales, and benefit interpretations...Remote jobWork from home
$236.5k
...million members as a clinical professional on our Medical Management/Health... ...timely and quality decision making. Supports effective... ...Chief Medical Director in planning and establishing... ...network providers, appeals team, medical and... ...to work with remote, hybrid, field or office...Remote jobFull timePart timeWork at officeFlexible hoursWeekend work$207.19k - $295.99k
...diseases with high unmet medical need. Learn more at... ...Scope:The Global Medical Lead (GML), Biopharma and Ophthalmology... ...(BOD), will lead the clinical development of 1 or... ...required for internal decision-making.Collaborate with... ...in Northbrook, IL. Remote work from anywhere in the...Remote workWork at officeWork from homeWorldwide- ...Health is seeking a Clinical Appeals Reviewer to review coverage... ...lines, ensuring medical necessity and adherence... ...with Medical Directors, interpret guidelines... ...reviews, and document decisions with thorough detail,... ...turnaround times in a remote environment. This remote...Remote jobWork from homeHome office
- Elevance Health seeks an Appeals Medical Director - Oncology to lead appeals reviews, guide clinical operations, and ensure timely provider and member responses. The role... ...clinical experience. It supports hybrid/remote work with required in-person training sessions...Remote jobRelocation
$116k - $182.27k
...DescriptionJob Description Job Title: Lead Clinical Study Manager (Lead CSM) BU/... ...and Flex Work Arrangement: Remote Job Code/ Job Profile: not... ...99263 Supervisor: Associate Director/Director, Study Management... ...periodic review of outputs, decisions and actions related to...Remote workMinimum wageContract workFor contractorsLocal areaFlexible hoursNight shift$328k
...DescriptionGeneral Summary:The Executive Medical Director, Global Medical Lead (GML), Pain is a critical... ..., in collaboration with Clinical Development, HEOR, RWE,... ...solutions and make decisions that maximize medical and... ...as: 1. Hybrid: work remotely up to two days per week;...Remote workFull timeSummer workFlexible hours2 days per week$143.32k - $273.93k
.... USAA roles may offer remote or hybrid flexibility for... ...Member Value Decision Science team, playing a... ...Decision Science Analyst Lead, you will be at the forefront... ...discretion of the USAA Board of Directors.The above description... ...include comprehensive medical, dental and vision...Remote workFull timeH1bWork at officeHome officeRelocation package- Mercor is seeking a Denials Management & Appeals Manager to lead operations focused on managing claim denials and appeals processes. This role... ...develop effective appeal strategies. This position is fully remote and offers competitive compensation. #J-18808-Ljbffr...Remote job
- Praxis, Inc. is seeking a Benefits & Appeals Platform Specialist for the GUST 23 project with Ohio Department of Job and Family Services. This role requires GSI platform expertise and experience in Ohio's public employment systems to support implementation and configuration...Remote job
- A leading healthcare solutions firm seeks a Payment Integrity Supervisor to oversee daily... ...assurance measures and resolving provider appeals. The ideal candidate will also ensure compliance... ...on improving service delivery. This remote position requires strong experience in...Remote jobDaily paid
$191.5k - $355.6k
...position is responsible for assigned aspects of medical policies and programs. Performs medical... ...of Osteopathic Specialists5 years of clinical experienceAnalytical and communication... ...specialties preferred but nt required This is a remote work from home role #LI-MG1Are you being...Remote workFull timeWork at officeWork from home$248.5k - $373k
...-based care. This full-time role offers remote work flexibility within the United States... ...your state. You will collaborate with medical director teams on inpatient care management, clinical coverage reviews, and provider appeals. The salary ranges from $248,500 to $373...Remote jobFull time- Liberty Healthcare Corporation is offering a full-time, remote-first Medical Director position. The role leads a large, geographically dispersed team conducting LTSS assessments for a large managed care system from a home office in New York. The position emphasizes quality...Remote jobFull timeHome office
- ...healthcare organization in Boston seeks a skilled Medical Director to oversee medical operations and clinical management. The role involves ensuring high-quality... ...work model, balancing in-office presence with remote work opportunities. A commitment to patient-centered...Remote workWork at office
$228.1k - $325.85k
...diseases with high unmet medical need. Learn more at... ...and iADCs). The Asset Lead has overall and primary... ...deliverables and day-to-day decision making for the asset(s)... ...nomination through clinical development, global/local... ...based in Northbrook, IL. Remote work from anywhere in...Remote workWork at officeLocal areaWork from homeWorldwide$248.5k - $373k
...73,000/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...flexibility to work remotely * from anywhere... ...with medical director teams focusing on inpatient... ...review, member appeals clinical review, medical... ...confidence to make autonomous decisions and an ability to...Remote workMinimum wageFull timeWork experience placementWork at officeLocal area- ...is seeking a PK/PD Module Expert to work remotely on a contract basis. The expert will... ...dose rationales, translate pharmacological decisions into AI training, and document decision-... ...communication skills, and experience in clinical governance. Ideal candidates will be comfortable...Remote jobContract work
$386.5k
...00/yearJob Area: Medical & Clinical OperationsCompany... ...Management. The Medical Director, Clinical AI... ...coverage decisions, support safe and... ...flexibility to work remotely * from anywhere within... ...from production, appeals, audits, and... ...scaleProven ability to lead through influence...Remote workMinimum wageFull timeWork experience placementLocal area$280.84k - $393.18k
...Services, the Senior Medical Director Policy & Outcomes... ...Policies and clinical leadership around... ...developing, executing, leading and updating... ..., grievance and appeals, delegation oversight... ....Ensure medical decisions are rendered by... .... (Mon & Fri - remote, Tues - Thurs onsite...Remote workTemporary workLocal area- ...Hospice Medical Director and Team Physician Find Your Passion... ...Type: Part Time Remote/Virtual Position: Hybrid... ...will serve as a key clinical leader for the hospice... ...clinical support. Lead and support hospice physicians... ...clinical judgment and decision-making skills. ~...Remote workPart time
- ...Incorporated is seeking an Executive Director, Global Medical Lead (GML) for their Boston office. This critical... ...Affairs and significant experience in clinical development. This role is hybrid-eligible, allowing flexibility between remote and on-site work arrangements, and...Remote workWork at office
$128.9k - $226.05k
...and care teams engage with UpToDate's clinical decision support products.At Wolters Kluwer Health... ...changes affect adoption and value. As Lead Product Analyst, CDS Adoption & Engagement... ...life, including but not limited to: Medical, Dental, & Vision Plans, 401(k), FSA/HSA...Full timeWork at office$80 - $90 per hour
Apply now: Lead Decision Science Analyst, Remote (EST/ CST hours). Start date is ASAP for this 6-Month Contract-to-Hire position. Job Title: Lead Decision Science Analyst Location-Type: Remote (CST/EST Hours required) Start Date: ASAP Duration: 6-Month Contract...Remote workContract workImmediate start$118.3k - $207.4k
...Wolters Kluwer Health, the UpToDate suite supports millions of clinical decisions every day. As AI changes how clinicians search for,... ...your work and personal life, including but not limited to: Medical, Dental, & Vision Plans, 401(k), FSA/HSA, Commuter Benefits,...Full timeWork at office- ...Plans in Virginia Beach region seeks a Director of Appeals and Grievance to plan, develop, and direct... ...Medicare lines of business. This role leads program development, strategic planning... ...appeals reporting, collaborate with Medical Directors to adjust criteria, and ensure...Remote job
- ...experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals operations across... ...strong background in clinical review, medical necessity denials, payer appeal... ...commercial plans. Experience managing remote and/or offshore teams (Philippines experience...Remote work
$110 - $130 per hour
...healthcare staffing company is seeking a Medical Director to lead utilization management and quality... ...improvement for Medicare inpatient care. This remote role requires board-certified... ...relationships, and driving medical necessity decisions. Competitive pay is offered at $110.00...Remote job
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