Remote Medical Director - Utilization Management (Remote)
$240kGrabJobs
Who We Are - Motivated by Purpose. Powered by Clinical Expertise. Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. WE OFFER A competitive compensation package Benefits include healthcare, vision, and dental insurance A generous 401(k) match Paid vacation, PTO, and holidays Growth and training opportunities An award-winning remote work environment Position Summary Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinicalquality management activities. Key Responsibilities Perform utilization management case reviews. Maintain productivity score per company standard. Maintain annual quality score per company standard. Complete annual inter-rater reliability testing. Train across all queues as requested by MRIoA leadership. Complete all client specific training as requested by MRIoA leadership. Maintain up-to-date records of case completion if required Consistently show willingness to take cases as requested. Demonstrate respect in interactions across the company. Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours. Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company). Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/oradministrative team. Actively participate in the MRIoA evaluation process (both company and individual). Participate in all company meetings and committees as requested. Complete other duties as requested or approved by the CEO and/or chief medical officer. Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards Work Schedule 40 hours per week Five 8-hour shifts or four 10-hour shifts (available after training) Shifts scheduled between6:00 AM – 7:00 PM MST Includes2–3 weekend rotating shifts per month Schedules are fixed and released60 days in advance Compensation & Expanded Benefits Base salary: $240,000 per year 20 days of Paid Time Off per year 6 company Holidays (New Year’s, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas) and 1 Floating Holiday 8 days of Paid Sick Leave Medical and Prescription Benefits administered by Aetna Dental and Vision benefits Basic Life and Accidental Death and Dismemberment (AD&D) Insurance Short-Term & Long-term Disability insurance Skills and Experience Minimum of five years’ full-time equivalent experience providing direct clinical care to patients Minimum of five years’ experience administering utilization management and peer review programs preferred Credentialed and privileged by the Company's Credentialing Committee Obtain additional state licensure as required for the position Education: MD/DO degree Current, unrestricted medical license as required for clinical practice in a state of the United States Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognizedby URAC preferred Additionally: Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy. Work Environment: Ability to sit at a desk,utilize a computer, telephone, and other basic office equipment is required. This role is designedto bea remote position (work-from-home). Diversity Statement: Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Drug-Free Workplace: This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment.All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. California Consumer Privacy Act (CCPA) Information (California Residents Only): Sensitive Personal Info : MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number. Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at View email address on click.appcast.io.
- ...Job Description\n Utilization Management Medical Director Oncology\n\n\n \n \n Work Location: REMOTE (work from home)\n \n \n The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with...Remote workWork from home
- ...Support utilization management processes and review authorizations for medical necessity. Perform peer-to-peer discussions with providers and mentor UM nurses.... ...-driven health insurance focused on seniors. Remote-first, mission-driven, and collaborative team....Remote work
$224k - $364k
~ Locations United States FL, United States (Remote) Job Description The Medical Director will work closely with the team to perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals...Remote workTemporary workPart timeWork experience placementInternshipSeasonal work- ...HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage...Remote work
$240k
...983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory... ...and training opportunities An award-winning remote work environment Position Summary Our Medical Director, also known as a Physician Advisor, is...Remote workFull timeTemporary workWork at officeWork from homeShift workRotating shiftWeekend work- ...Clover Health is seeking a Lead Medical Director, Utilization Management, to guide medical necessity decisions for outpatient referrals and inpatient... ...committees, and drive quality improvements, all within a remote-first framework supporting US operations. #J-18808-LjbffrRemote work
$332.3k - $377.4k
...Idaho, Nevada and Colorado, is seeking an experienced Medical Director with expertise in Utilization Management (UM), Care Management (CM) and Health Plan... ...Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work...Remote workHourly payLocal areaRelocation package- ...Centene Corporation seeks a Psychiatrist to serve as Behavioral Health Medical Director in a fully remote capacity across the United States. You will guide medical management, utilization, quality improvement, and credentialing, collaborating with multidisciplinary teams...Remote work
- ...Lead UM Medical Directors in making timely, evidence-based medical necessity decisions. Evaluate outpatient... ...appropriateness. Key Responsibilities: Manage a team, review complex cases, and chair the Utilization Management Committee. Partner with clinical...Remote workFlexible hours
$320k - $340k
...listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Medical Director, Utilization Management based in the United States.... ...quality, access, and outcomes. This remote-first role combines hands-on clinical judgment...Remote workFull timeWork at officeFlexible hours$320k - $340k
...those who need it most. The Utilization Management team supports access to... ...through timely, evidence-based medical necessity decisions and... ...policies. The Lead Medical Director, Utilization Management, will... ...Additionally, we embrace a remote-first culture that supports...Remote workFull timeWork experience placementWork at officeLocal areaFlexible hours- GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate holds...Remote job
- SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while...Remote job
- ...Medical Review Institute of America is seeking a Medical Director (Physician Advisor) to lead clinical utilization management, peer review activities, and clinical quality management. This remote role reports to MRIoA leadership and offers a comprehensive compensation...Remote work
- ...Centene Corp. seeks a Medical Director (PRN) to assist the CMO in directing physician utilization management for the health plan units. The role is roughly 20 hours per week with Thursdays and Fridays as the highest priority. Board-certified MD/DO with Indiana license...Remote workPart timeRelief
- Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length: 6-9 months, with potential for extension Schedule: Standard business hours; schedule to be determined with the client Start Date: Immediate...Remote workHourly payContract workImmediate start
- ...VetJobs seeks a Medical Director (BH, UM) based remotely with Hawaii licensure to lead clinical operations for... ...of an interdisciplinary care management team across inpatient, partial hospitalization... ...include developing utilization management strategies, ensuring medically...Remote work
$248.5k - $373k
...2345838 **Job category:** Medical & Clinical Operations WellMed... ...physician to join our Utilization Management team. Optum is a clinician-... ...work and live. The Medical Director for Utilization Management... ...enjoy the flexibility to work remotely * from anywhere within the...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$238k - $357.5k
...currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is... ...support staff to manage inpatient care utilization at a hospital, market, regional or... ...’ll enjoy the flexibility to work remotely * from within the State of Missouri...Remote jobMinimum wageFor contractorsWork experience placementLocal area- CVS Health is seeking a Medical Director to lead medical management for Medicaid populations with a national scope, primarily supporting Aetna Better Health of Louisiana. In this remote role, you will oversee utilization management, prior authorizations, and peer-to-peer...Remote job
- Magellan Health is seeking a Medical Director (BH, UM) for a remote position servicing Hawaii. The role requires Hawaii licensure and supports... ...involves physician oversight of an interdisciplinary team, utilization management, quality improvement, and collaboration with...Remote jobFull timePart time
$213.1k - $308.3k
...primary care, care for the most medically and socially complex populations,... ...communities we serve. The Job The Utilization Management (UM) Physician Medical Director provides physician-level clinical... ...,301 per year Work Mode - Mostly Remote: Employees who reside outside the...Remote workFor contractorsWork at officeLocal areaRelocation- ...Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute... ...align with CMS, policies, and evidence-based criteria. Remote opportunity in New Jersey for a board-certified...Remote work
$75.3k - $135.4k
...Supervises the behavioral health (BH) utilization review clinicians to ensure... ...activities of BH utilization management team. Key Details: Are you... ...know? Centene is seeking a remote Supervisor, Behavioral Health... .... Understanding of medical necessity criteria for a broad...Remote workFull timePart timeWork at officeFlexible hours- ...A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands a blend of clinical experience, leadership, and the ability to guide a team while ensuring compliance...Remote workContract workWeekend work
- ...Alliance Health in Morrisville, NC, is seeking a Director of Utilization Management for Physical Health. This full-time remote role requires travel to the Morrisville home office for occasional onsite meetings. Lead a multidisciplinary UM team to ensure appropriate...Remote workFull timeHome office
- ...CareStar, Inc. in Ohio is seeking a Clinical Services Utilization Supervisor to oversee Hamilton County and surrounding areas. You will... ...coordinate services with Medicaid and state programs. This remote with field visits role offers flexibility, competitive salary...Remote work
- ...Primary Work Location : Remote (Oregon Headquarters). This position... ...(Salaried) Division: Utilization Management Physical Strength: Light (L) Reports To: Nursing Director - RN Work Location Type:... ...Collaborates with the YCCO Chief Medical Officer (CMO) and/or...Remote workContract workFor contractorsCasual workWork at officeLocal areaFlexible hours
- ...Centene Corp. is seeking a remote Supervisor of Behavioral Health Utilization Management to lead a PIC ABA team of certified BCBAs. The role involves guiding clinicians, ensuring compliant utilization review, and collaborating with providers and health plan partners...Remote work
- ...Highmark Health is seeking a full-time RN Case Manager for a remote role requiring weekend availability and three weekdays. You will implement utilization management strategies, review care appropriateness, and coordinate referrals to Health Coaching and case management...Remote workFull timeWeekend workWeekday work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Director - Utilization Management (Remote). Be the first to apply!
- director of health information management Davenport, IA
- health services director Davenport, IA
- occupational health manager Davenport, IA
- public health director Davenport, IA
- clinic supervisor Davenport, IA
- health manager Davenport, IA
- healthcare supervisor Davenport, IA
- medical coding supervisor Davenport, IA
- health services manager Davenport, IA
- remote healthcare project manager Davenport, IA


