Remote Medical Director, Utilization & Policy
$173k - $250kWellSense Health Plan
- Remote job
WellSense Health Plan in Boston seeks a Medical Director to oversee clinical activities and support quality management initiatives. The ideal candidate will have over 8 years of experience, including extensive clinical and medical management expertise. Responsibilities include conducting reviews of medical necessity and participating in clinical committees. This role offers a full-time remote work opportunity with a competitive salary range of $173,000 - $250,000. WellSense prioritizes member-centered care and values diversity and inclusion. #J-18808-Ljbffr WellSense Health Plan
$238k - $357.5k
...Medical Director Oncology Optum is a global organization that delivers... ...Oncology will provide utilization review determinations and support... ...the flexibility to work remotely from anywhere within the U.... ...ensure all clinically relevant policies and processes are informed...Remote jobPolicyFull timeWork experience placement$248.5k - $373k
...Medical Director Oncology Optum is a global organization that delivers... ...Oncology will provide utilization review determinations and support... ...the flexibility to work remotely from anywhere within the U.... ...ensure all clinically relevant policies and processes are informed...Remote jobPolicyMinimum wageWork experience placementLocal area$248.5k - $373k
...Medical Director For Utilization Management WellMed, part of the Optum family of businesses, is seeking... ...'ll enjoy the flexibility to work remotely from anywhere within the U.S. as you... ...practice of medicine guidelines, and UM policies and procedures with counsel when...Remote workPolicyMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$240k - $250k
...Medical Director Utilization Management We are looking for physicians who have expertise in Internal... ...backgrounds and perspectives. This is a remote-first role that may require travel to... ...across the care continuumincluding policy, prior authorization, payment...Remote workPolicyFlexible hours$275k - $325k
..., TOI is changing oncology for the better. Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California Nevada Arizona... ...insights, and oversight of utilization management policies to optimize patient outcomes. Key...Remote workPolicyWork from home- ...Description & Requirements System Medical Director, Pre-Surgical Optimization... ...Improve preoperative clinic utilization, reduce elective case... ...efficiency. Develop triage policies and clinical criteria to... ...process enhancements. Provide remote and on-site clinical support...Remote workPolicyFull timeLocal areaImmediate start
$207k - $253k
...value to those who need it most. The Medical Director, Utilization Management, will be responsible for... ...Criteria, Clover Health’s medical policies reviews to determine medical necessity... ...off policy. Additionally, we embrace a remote-first culture that supports...Remote jobPolicyWork experience placementWork at officeLocal areaFlexible hours$174.07k - $374.92k
...for a Board-certified Psychiatrist licensed in Kentucky for a remote role. You will oversee a utilization management team and provide leadership in quality care delivery while participating in medical policy development and managing high‑risk cases. Experience in managed...Remote workPolicy$223.8k - $313.1k
Medical Director physician employment in Texas : Become a part of our caring... ..., CMS requirements, Humana policies, clinical standards, and... ...Intermediate to advanced skills utilizing Microsoft Office and... ...Information Workstyle: Remote work at home Hours: Must...Remote workPolicyTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeWork visaMonday to Friday$250k
...home, multidisciplinary medical group providing 24/7... ...Description: The Medical Director will partner with... ...need, high-risk, high-utilizing patients. Job requires... .... The role is primary remote, but residence in the... ...and provider systems, policies, and regulations to...Remote workPolicyFlexible hours- ...counseling, peer support, medication-assisted treatment (... ...to add a Medical Director to our dynamic team. Founded... ...Predominately Remote Position requires 1 (one... ...orders Participate in utilization review Attend and participate... ...robust paid time off policy to support work‑life...Remote workPolicyHourly payPart timeReliefFlexible hours
$207.8k - $346.3k
...Medical Director Do you crave an intellectually stimulating role that... ...You'll start training remotely in a structured environment... ...applicable state and federal laws, Utilization Review Accreditation Commission... ...Group has a tobacco-free policy and reserves the right not to...Remote workPolicyLocal areaWork from homeMonday to Friday$140 - $145 per hour
...Medical Director – Surgery, Orthopedics & PM&R Role Summary Are you an accomplished... ...role focuses completely on utilization management, medical... ...days per week) to TriWest's remote administrative operations and... ...with network providers. Policy Development: Provide expert...Remote workPolicyHourly payLocumPrivate practice3 days per week1 day per week- ...in Brighton, MA office; 1 day remote from home FLSA Status: Exempt Position Summary The Medical Director oversees all medical and... ...clinical insight in areas such as utilization management, case management,... ...execute utilization management policies and work plans with the Plan’...Remote workPolicyContract workWork at officeLocal area
$248.5k - $373k
...Stay Billing Validation (SSBV) Medical Director to join our Clinical and... ...enjoy the flexibility to work remotely * from anywhere within the U... ...(e.g., InterQual or MCG) in utilization review or payment integrity... ...UnitedHealth Group's Telecommuter Policy Pay is based on several...Remote workPolicyMinimum wageFull timeWork experience placementLocal area$200k
...job poster from Theoria Medical Company Overview... ...multispecialty physician services, remote patient monitoring, and... ...+ monthly Medical Director Stipend and this... ...Physician must be able to utilize electronic/online medical... ...Paid - Life Insurance Policy; Employee must be able...Remote workPolicyFull timePart timeRelocation packageFlexible hoursShift workDay shift2 days per week3 days per week$170 - $175 per hour
...Medical Director Req number: R7707 Employment type: Full time Worksite flexibility: Remote Who we are CAI is a global services firm with over... ...Medical Director to ensure utilization management responsibilities... ...escalated cases against medical policy criteria, which may...Remote workPolicyHourly payFull timePrivate practiceWork at officeLocal areaWorldwide$225.7k - $428.9k
...We’re Hiring: Full time Medical Director for our Health Plan in South Carolina... ...leadership of all for utilization management, cost containment... ...and establishing goals and policies to improve quality and cost-... ...flexible approach to work with remote, hybrid, field or office...Remote workPolicyFull timePart timeWork at officeFlexible hoursWeekend work$248.5k - $373k
...Medical Director Optum is a global organization that delivers care,... ...clinical knowledge in various utilization management activities with... ...the flexibility to work remotely from anywhere within the U.... ...proprietary coverage review policies, render coverage determinations...Remote workPolicyMinimum wageWork experience placementLocal area$223.8k - $313.1k
...our caring community The Medical Director relies on medical background... ...Medicine, or those experienced in Utilization Review are encouraged to... ..., CMS regulations, Humana policies, and recognized clinical standards... ...Travel: While this is a remote position, occasional travel...Remote workPolicyBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$227.6k
...Job Title Utilization Management Physician Job Summary This job, as part of a physician team, ensures that utilization management... ...incumbent reviews escalated cases electronically and using medical policy criteria sets to evaluate the medical necessity and...Remote workPolicyFor contractorsPrivate practiceWork at officeLocal area- ...MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This... ...and ensuring compliance with Medicare policies, reviewing medical claims, and promoting... ...in the health insurance industry, a utilization review firm, or another health care...Remote workPolicyPermanent employmentFor contractorsWork experience placementLocal areaImmediate start
- ...leading U.S. healthcare organization is seeking an experienced Medical Director to conduct clinical reviews and guide decision-making in... ...clinical experience, with a focus on hospital medicine and utilization review. Join a distinguished team to impact patient outcomes...Remote work
$250k - $350k
...company, is a specialized medical group dedicated to... ...longitudinal care management, remote monitoring, and real-... ..., reduce avoidable utilization, and expand access for... ...Title: Medical Director Intention MA Location... ...and organizational policies Conduct periodic ride...Remote workPolicy- ...A leading healthcare company in Washington, D.C. is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency...Remote work
- ...A national healthcare organization is seeking a Medical Director to conduct inpatient medical necessity reviews while collaborating with... ...Responsibilities include performing clinical reviews, providing utilization management determinations, and ensuring compliance with...Remote workMonday to Friday
- ...Contact Centre (RCC), the TOP Medical Director – LAC RCC is responsible for... ...of all TRICARE Prime Remote regional clinical operations... ...quality case quality meetings, utilization review escalations. Provide... ...promote all International SOS’s policies, procedures and corporate...Remote workPolicyFull timeContract workWork experience placementLocumWork at officeWorldwideRelocationOverseasMonday to FridayDay shiftAfternoon shiftWeekday work
$202k - $303k
Excellus BCBS is looking for a Medical Director to oversee Utilization Management, guiding medical policies and ensuring compliance with regulations. This role involves... ...of $202,000 to $303,000, along with potential remote work opportunities. Essential qualifications include...Remote jobPolicy- ...Medical Director, Utilization Management The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Utilization...PolicyFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- ...Overview An Associate Medical Director will be joining a dynamic experienced clinical... ...include the aspects of utilization management as guided by medical policy for both medical and pharmacy benefits... ...experience. Additional Remote work is a consideration following...Remote workPolicy
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