Utilization Management Medical Director - Remote (MO license required)
$238k - $357.5kUnitedHealth Group
- Remote job
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together . We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level. You’ll enjoy the flexibility to work remotely * from within the State of Missouri as you take on some tough challenges. Primary Responsibilities: Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence – based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations Is grounded in the use and application of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers Maintain proficiency in all required software and platforms Although the Optum ICM Medical Director’s work is typically concentrated in a region, they are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country. In response to customer needs and expectations, Optum is continuously modifying its programs and approaches. Although not a primary job function, Medical Directors with the interest in doing so often can be involved with change design and management. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: MD or DO with an active, unrestricted medical license [Missouri state medical licensure required] Current Board Certification in an ABMS or AOA specialty 3+ years of clinical practice experience post residency Technical proficiency in computer software and systems
- MUST reside in the state of Missouri
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- ...GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review... ...cases. The ideal candidate holds a Florida medical license (MD/DO), BS/ABMS board certification or eligibility,...Remote work
- ...Humana Inc is seeking a Medical Director to lead inpatient medical necessity reviews and utilization management with a focus on quality... ...care standards. This remote position requires MD or DO, board certification... ..., and a valid medical license, with 5+ years post-...Remote work
$320k - $340k
...partner company, who manages all applications and... ...looking for a Lead Medical Director, Utilization Management based in... ...and outcomes. This remote-first role combines... ...provider experiences. Requirements: MD or DO... ...medical license. Board certification...Remote workFull timeWork at officeFlexible hours$224k - $364k
...States FL, United States (Remote) Job Description The Medical Director will work closely with... ...perform all types of utilization management (UM) reviews,... ...organization Position Requirements: • Current unrestricted Florida medical license as a Doctor of Medicine...Remote workTemporary workPart timeWork experience placementInternshipSeasonal work$320k - $340k
...need it most. The Utilization Management team supports... ..., evidence-based medical necessity decisions... ...The Lead Medical Director, Utilization Management... ...plan is required for our members.... ...unrestricted medical license. You are board... ..., we embrace a remote-first culture that...Remote workFull timeWork experience placementWork at officeLocal areaFlexible hours- SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews... ...with RN reviewers and UM leadership.The role requires an active MD/DO license and board certification, 5+ years of clinical...Remote job
- ...Staffing is urgently seeking a Medical Director of Utilization Management to join a leading... ...compliance. Location: 100% Remote Schedule: Full-Time,... ...escalated or complex UM cases requiring expert medical judgment.... ...Will Bring Credentials: Licensed M.D. or D.O. in good...Remote workFull timeMonday to Friday
- Medical Director, Utilization Management Location: New Jersey - Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length... ...state and federal requirements. Participate in utilization... ..., unrestricted M.D. or D.O. license in good standing. Current board...Remote workHourly payContract workImmediate start
$248.5k - $373k
...Medical Director For Utilization Management WellMed, part of the Optum family of businesses... ...the flexibility to work remotely from anywhere within the... ...may be interested in. Required Qualifications: ~ Doctor... ...active, unrestricted medical license (any state) ~5+ years of...Remote jobMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- ...certified psychiatrist to lead and oversee utilization management, focusing on high-risk cases, medical necessity decisions, and behavioral health... ...weekend rotation and cross-state licensure capabilities. Texas license or eligibility is required. #J-18808-Ljbffr CVS HealthRemote jobWeekend work
$75.3k - $135.4k
...behavioral health (BH) utilization review clinicians... ...BH utilization management team. Key... ...Centene is seeking a remote Supervisor,... ...corrective action when required Assists with... ...related experience. License to practice... ...Understanding of medical necessity criteria...Remote workFull timePart timeWork at officeFlexible hours$213.1k - $308.3k
...care for the most medically and socially... ...serve. The Job The Utilization Management (UM) Physician Medical Director provides physician... ...regulatory requirements, and NCQA/URAC accreditation... ...or Licenses: Medical License... ...Work Mode - Mostly Remote: Employees who reside...Remote workFor contractorsWork at officeLocal areaRelocation$52 - $56 per hour
...letter, and you'll apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/... ...case files for Medical Director review • Write clear, compliant... ...New York State RN license (compact alone does not qualify...Remote jobContract workAfternoon shift$60.52k - $129.62k
...Clinical Case Manager – Behavioral Health (Licensed) 100% Remote | Work from Anywhere in the U.S.... ...complex health needs Utilize Motivational Interviewing... ...interactions What You Bring - Required ~ Master's Degree... ...this position include medical, dental, and vision...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to Friday- ...The best fit has a utilization management or case... ...understand both medical necessity and the... ...files for Medical Director review and work with... ...authorization requests where required for certain... ...York State RN license. Compact or other... ...once in a fully remote setting. Nice...Remote job
$215.01k - $408.49k
...physician component of the utilization management functions for the... ...MD or DO state license. The ideal candidate... ...priority. Provides medical leadership for utilization... ..., and accreditation requirements. Identifies utilization... ...to work with remote, hybrid, field or office...Remote workHourly payFull timePart timeReliefWork at officeFlexible hours$215k - $408.5k
...Assist the Chief Medical Director to direct and... ...coordinate the medical management, quality... ...leadership of all for utilization management, cost... ...accreditation requirements. ~ Assists... ...population preferred. License/Certifications:... ...to work with remote, hybrid, field...Remote workFull timePart timeWork at officeFlexible hoursWeekend work$65k - $85k
...Position Summary The Licensed Vocational Nurse (LVN) – Utilization Management & Inpatient Case... ...of high-quality, medically appropriate, cost... ...needs require. The LVN works... ...independently in a fully remote environment.... ...to an RN, Medical Director, or other designated...Remote workWork at office$28.28 - $47.13 per hour
...Behavioral Health Utilization Care Manager , you will be... ...concurrent reviews for medical necessity. You... ...to meet requirements for compliancy and... ...will be entirely remote . This position... ...regularly with medical directors. Within the... ...family. Appropriate licenses include: LCSW,...Remote workWork experience placementWork at officeMonday to FridayShift work- ...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
- ...healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role... ...information, determining medical necessity for services, and collaborating... ...with flexible weekends and requires an active PA RN license. #J-18808-Ljbffr The Judge...Remote jobFlexible hoursWeekend workDay shift
$174.07k - $374.92k
...resources. This is a remote based (work from... ...and current US medical license without... ...In the Medical Director role you will provide... ...Aetna's medical management programs to address... ...primarily on overseeing utilization review / quality... ...teams. Required Qualifications:...Remote workHourly payFull timeTemporary workLocal areaWork from home$207.17k - $336.75k
...Associate Medical Director - Part Time Work from... ...clinical staff on case management reviews and... ...Qualifications: Licensed Physician with an... ...Certification required. Qualification by... ...care management, utilization management and quality... ...a team. #LI-Remote Pay ranges...Remote workPart timeLive inImmediate startWork from homeFlexible hours$227.6k
...Job Title Utilization Management Physician Job Description This job... ...cases electronically and using Medical Policy criteria sets to... ...to peer discussions may be required. The incumbent ensures compliance... ...care industry Licenses and Certification Required...Remote workFor contractorsPrivate practiceWork at officeLocal area$60.52k - $129.62k
Clinical Case Manager - Behavioral Health (Licensed) We’re building a world of... ...complex health needs Utilize Motivational... ...interactions WHAT YOU BRING - REQUIRED Master's Degree in... ...Why Join Us? Fully remote position available anywhere... ...families. Benefits medical dental vision...Remote workHourly payFull timeTemporary workWork experience placementLocal areaMonday to Friday$216.11k - $283.64k
...hiring an Associate Medical Director, Regulatory Management to join our... ...position is fully remote and open to candidates... ...occasional travel required for team meetings and... ...regulations - verifying licenses, board... ...Prior experience with Utilization management. This...Remote workFull timeWork at officeWork from homeHome office- ...Telix The Associate Medical Director, Prostate Cancer... ...prostate oncology experience required or equivalent... ...intelligence, clinical utility evidence, and evolving... ...~ Valid driver’s license. Key Capabilities... ...medicine. We have hybrid and remote employees located all...Remote workFull timeWork at office
- Position Summary The Utilization Management Clinical Consultant (UMCC... ...to assess the medical necessity, appropriateness... ...clinical interventions when required, including triage and... .... Notes This is a remote position but does require a BH licenses, those have to be active...Remote workMonday to Friday
- ...Job Description Location: Fully Remote | Candidates must be available to work... ...physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post-Acute) role... ...Active, unrestricted state medical license (MD/DO) in any US jurisdiction....Remote workPart timeLocal areaImmediate startWork from home
- 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... ...position offers a contract employment type and requires working 40 hours a week with some weekend coverage...Remote jobContract workWeekend work
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