Remote Medical Director - Appeals & Quality Improvement
Centene Corporation
Centene Corp. is seeking a Remote Medical Director, Appeals to lead medical management, utilization review, and quality improvement for our national program.
You will provide medical leadership across utilization management, cost containment, and clinical quality initiatives while coordinating with care management teams and network providers to optimize outcomes for our 28 million members.
#J-18808-Ljbffr$248.5k - $373k
...73,000.00Job Area: Medical & Clinical OperationsCompany... ...barriers to quality care. The work you... ...to work remotely * from anywhere within... ...Responsibilities:The Appeals and Grievances Medical Director is responsible for... ...problem solving, process improvement, staff training and...Remote workMinimum wageWork experience placementLocal areaWork from home- ...diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal...Remote workFlexible hours
$236.5k
...clinical professional on our Medical Management/Health... ...Purpose: Supervisory Medical Director at Centene provides... ...to ensure high-quality, cost-effective care for... ...actively participates in the appeals process, ensuring that... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hours$118.4k - $219k
...for this job have the flexibility to work remote from home anywhere in the United States.... ...Purpose: Lead and direct process improvement initiatives by utilizing process improvement... ...administration, coordination and evaluation of quality assurance and training, including policy...Remote workFull timePart timeWork at officeWork from homeFlexible hours- ...PharmaceuticalsSelling Points Drive clinical quality excellence in a hybrid executive role.... ...for compliance and operational improvement.Travel as needed to conduct audits and collaborate... ...corrective action plans.Supervise remote vendor audits, ensuring thorough follow-...Remote work
- Director, Clinical Quality ImprovementDetroit, MIDrive Systemwide Excellence in Clinical Quality & PerformanceA... ...Director of Clinical Quality Improvement to oversee quality initiatives,... ...access solutions across Healthcare, Medical Device, Construction/Engineering, Government...Permanent employment
- ...organized Manager of Clinical Appeals to lead our clinical... ...execution, ensuring quality and compliance, and... ...in clinical review, medical necessity denials, payer... ...and implement process improvements to increase efficiency... .... Experience managing remote and/or offshore teams...Remote work
- ...A leading virtual health company is seeking a Director of Clinical Quality to oversee its clinical quality functions in the... ...health, including expertise in quality improvement and utilization management. This is a remote position with a focus on maintaining high standards...Remote work
- ...Centene Corp. seeks a Director of Quality & Process Improvement to lead HEDIS audit readiness and process improvement initiatives. This position involves... ...data analysis to enhance operational effectiveness. Remote work options available along with a comprehensive benefits...Remote work
$140k - $175k
...About the Role The Director of Clinical Quality serves as Equip's primary owner of... ...implementing, and continuously improving clinical quality functions... ...directly to the VP of Medical Operations & Quality and serves... ...or compliance staff) in a remote or telehealth setting. Proven...Remote workWork at officeLocal areaWork from homeHome officeFlexible hours- ...is seeking a clinician to review appeals and grievances across PPO, HMO, MAPD... ...responses and collaboration with medical directors and network staff. We offer remote work from anywhere in the U.S.... ...project-management skills to help improve care access and outcomes. #J-18...Remote work
- ...organization is seeking a Neurologist Medical Director to ensure compliance with clinical guidelines... ..., offering clinical guidance, and improving care delivery. Candidates must be board... ...medical license. This position is primarily remote, offering a full-time work schedule...Remote workFull time
$280.84k - $393.18k
...Health Services, the Senior Medical Director Policy & Outcomes (Sr.... ...activities including quality management, grievance and appeals, delegation oversight, and... ...initiatives, and other improvement activities. This position... ...schedule. (Mon & Fri - remote, Tues - Thurs onsite in...Remote workTemporary workLocal area$248.5k - $373k
...3,000.00Job Area: Medical & Clinical OperationsCompany... ...will directly improve health outcomes by... ..., the Medical Director provides... ...responsible for the overall quality, effectiveness and... ...and provider appeals. In addition, the... ...flexibility to work remotely * from anywhere within...Remote workMinimum wageWork experience placementWork at officeLocal area- JOB DESCRIPTION Job Summary Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. Provides subject matter expertise in planning and implementing QI initiatives and education programs to support improved Medicare...Remote workWork at office
$248.5k - $373k
...**Job category:** Medical & Clinical Operations... ...will directly improve health outcomes by... ...Optum, the Medical Director provides leadership... ...for the overall quality, effectiveness and... ...discussions and provider appeals. In addition, the... .... This can be remote work from home...Remote workMinimum wageFull timeWork experience placementLocal areaWork from homeMonday to Friday$110 - $130 per hour
...Title: Medical Director Location: Remote Duration: 6 Months with possible extension/Conversion FTE We’re hiring a board... ...Director to lead utilization management, quality improvement, credentialing, and appeals for high-volume inpatient and post-acute care...Remote work$248.5k - $373k
...3,000.00Job Area: Medical & Clinical OperationsCompany... ...will directly improve health outcomes by... ....The Medical Director for the... ...flexibility to work remotely * from anywhere within... ...Responsibilities:Work to improve quality and promote... ...review, member appeals clinical review,...Remote workMinimum wageWork experience placementLocal area$215k - $270k
...Medical Director (MD or DO) (NHC-1455120) Raleigh, North Carolina... ...Location: Primarily Remote (North Carolina... ...This role ensures high-quality, compliant, and defensible... ...initial, concurrent, and appeal utilization management... ...complex cases and improve care delivery processes...Remote workFull timeWork visaMonday to FridayAfternoon shift- ...enthusiastic and highly skilled Medical Director to join our growing... .... This is a remote position requiring a "... ...relevant regulations and appeal processes. Collaborate... ...management processes and improve member outcomes.... ...protocols. Participate in quality improvement...Remote workFull timeFlexible hours
$79.8k - $126k
...consolidating pharmacy and medical benefit... ...the Lead Medical Director. This position transacts... ...authorization and appeals) and responds to... ...delivering high-quality work Minimum... ...environment, quality improvement and UM practices... ...location of the job. Remote, US Salary Range $...Remote workWork at officeLocal areaFlexible hoursShift work- ...Overview The Contractor Medical Director (CMD) is responsible... ...Law Judge appeals hearings, and performing... ...program integrity and high‑quality care for Medicare beneficiaries... ...opportunities for improvement or interventions to... ...Health and Hospice. Remote Work Requirements...Remote workContract workFor contractorsLive inLocal areaImmediate start2 days per week
$225.7k - $428.9k
...re Hiring: Full time Medical Director for our Health Plan in... ...to affordable, high-quality services to Medicaid... ...management, quality improvement and credentialing functions... ..., network providers, appeals team, medical and... ...approach to work with remote, hybrid, field or...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$320k - $350k
...drive groundbreaking medical discoveries and... ...SummaryThe Senior Medical Director serves as a key... ...to ensure high‑quality, cost‑effective... ...clinical strategies that improve member outcomes,... ...escalated cases, appeals, and grievances,... ...(if applicable)Remote TypeRemoteWork Location...Remote workFull time$286.07k - $353.38k
...SummaryThe Vice President, Medical Director, Health Plan provides senior... ...Health Plan, with a focus on quality, affordability, compliance,... ...requirements, including clinical appeals and grievances, using sound... ....Develop strategies to improve medical expense management,...Remote workFull timeHome office- ...barriers to optimal health. As a Health Improvement Manager, you will represent Wellmark with... ...’s Des Moines office with 2 days remote option (Mon/Fri). You may be in-office Mondays... ...subject matter experts to deliver high quality educational opportunities that strengthen...Remote workPermanent employmentTemporary workWork experience placementH1bWork at officeLocal areaMonday to FridayFlexible hoursNight shift
- ...Medical Director Utilization Management Location: Remote Preference EST or nearby Pittsburgh PA, NY, WV Duration: 6+... ...also be assigned to support and improve member care. Responsibilities... ...Complete initial determinations, appeals, grievances, and other reviews as...Remote workContract workPrivate practice
- ...Medical Director Utilization Management (Payer Side Experience Required)- (Remote) Duration: 30 Weeks with possible extension Location:... ...medical necessity reviews, appeals, and escalated case evaluations... ...initiatives focused on improving member care and clinical outcomes...Remote workFull timeContract workPart timePrivate practiceMonday to FridayFlexible hours
$233k - $302k
...Medical Director, Quality and Value-Based Performance Newport News, Virginia Medical Director, Quality and Value-Based Performance Riverside... ...across all value-based initiatives, with a focus on improving quality, outcomes, utilization, and financial performance...Full time$160k - $187k
...Senior Manager, Clinical Quality Assurance Boston, MA or Remote Responsibilities Reporting to the Executive Director of Quality Assurance, the Senior Manager, Clinical Quality... ...in identifying opportunities for process improvement initiatives, including process/program...Remote workSummer holidayWork at officeHome office
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