Remote Medical Director, Claims & Utilization Review
RXinsider LTD.
UnitedHealth Group (Optum) is seeking a Medical Director to provide physician support to Enterprise Clinical Services, shaping clinical coverage determinations, quality improvement, and cost-effective care for members. You will collaborate with network and non-network physicians to ensure compliant, evidence-based decisions.
You will lead clinical rounds, communicate effectively, and drive patient-centered care while advancing operational policies in a large, multi-disciplinary team.
#J-18808-LjbffrVacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Medical Director, Claims & Utilization Review in Atlanta, GA vacancy
- ...UnitedHealth Group (Optum) is seeking a Medical Director to provide physician support to Enterprise Clinical Services, shaping clinical coverage determinations, quality improvement, and cost-effective care for members. You will collaborate with network and non-network...Remote workClaims
RXinsider
United States23 hours ago $240k - $250k
...Medical Director Utilization Management We are looking for physicians who have... ...appropriateness of services by reviewing clinical information and... ...perspectives. This is a remote-first role that may require... ...authorization data with post-service claims validation, we're creating...Remote workClaimsFlexible hoursVenturefizz Product Management Community
United States4 days ago$223.8k - $313.1k
...our caring community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments... ..., or those experienced in Utilization Review are encouraged to... .... Travel: While this is a remote position, occasional travel to...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend workHumana
Topeka, KS1 day ago- ...To support Utilization Management operations, the full-time Utilization Review Medical Director will conduct clinical reviews of Durable Medical Equipment (DME) requests remotely, ensuring compliance with Medicare and Medicaid guidelines while maintaining productivity...Remote workFull time
Virtual Vocations Inc
United States1 day ago - ...Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides... ...planning and utilization review.Responsibilities:•... ...concurrent and retrospective medical necessity and/or compliance... ...precertification, reimbursement and claim denials/appeals.•...Remote workClaims
First Connect Health
Austin, TX5 days ago - ...seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule... ...Monday - Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing...Remote workClaimsFor contractorsMonday to FridayFlexible hours
Dane Street
United States4 days ago - Integra Partners seeks an experienced Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a remote UM environment. You will ensure decisions meet Medicare/Medicaid guidelines and internal policies while maintaining timely throughput and...Remote job
$248.5k - $373k
...deliver clinical coverage and medical claims reviews. Our role is to empower... ...health care costs. The Medical Director provides physician support... ...knowledge in various utilization management activities with... ...skills *All employees working remotely will be required to adhere...Remote jobClaimsMinimum wageFull timeWork experience placementLocal area- ...Medical Director Curative is seeking an enthusiastic and highly skilled Medical Director... ...responsible for overseeing and performing utilization reviews, prior authorizations, and making... ...peer-to-peer discussions. This is a remote position requiring a "roll up your sleeves...Remote workFull timeFlexible hours
$150 per hour
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support... ...Working Conditions and Additional Expectations: Remote role requiring consistent availability during standard business...Remote workHourly payFull timeContract workTemporary workPart timeLocal areaIntegra Partners
Troy, MI20 days ago- Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast...Remote jobFull time
- ...Description Job Description The utilization review and management (UM)... ...MedHealth contracted facilities are medically necessary, clinically... ...logging and documentation of claims along the process chain. #... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
MedTrust LLC
Oklahoma City, OK7 days ago - UnitedHealth Group's Optum unit seeks a Medical Director to lead the Focus Claims Review program, overseeing medical services, provider discussions, and policy... ...and coordination across reviews. You can work remotely from anywhere in the U.S. The position requires an active...Remote jobClaims
- ...efficiency of the use of Medical Services for Long-... ...and concurrent review. Provides monthly... ...setting by utilizing the applicable medical... ...Works with medical directors in interpreting... ...care and accurate claims payment. May also... ...Additional Info: *possible remote opportunity after...Remote workClaimsContract workMonday to FridayFlexible hours
HealthCare Support
New York, NY1 day ago $2,210 per week
...and benefits, including medical, dental, vision, long-... ...Holidays Work-life balance. Remote/hybrid setting (once... ...: This individual will utilize clinical knowledge and... ...to a second level reviewer. This individual interfaces... ...'s status, benefit and claim concerns, and validation...Remote workClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hoursHines
Freeport, IL2 days ago- ...The Utilization Review Nurse gathers demographic and clinical information... ...patient treatment, certifies the medical necessity and assigns an... ...department and of CorVel. This is a remote position. ESSENTIAL... ...concern to the appropriate claims staff/customer Collects data...Remote workClaimsMinimum wageWork at officeLocal areaFlexible hours
CorVel
Rancho Cucamonga, CA1 day ago - Optum seeks a Medical Director to provide physician support for Enterprise Clinical Services, focusing... ...decisions. You will lead clinical reviews, collaborate with hospital networks,... ...practice, and strong communication skills; remote-friendly with comprehensive benefits....Remote jobClaims
- ...New Horizons is seeking an Utilization Review Specialist , who will be responsible... ...portal, review patients medical record via EMR to ensure criteria... ...or denial of accounts to Director of Revenue or designee Trends disputed claims by payor Obtain & follow authorization...Remote workClaimsLocal area
New Horizons
United States3 days ago $30.64 - $45.8 per hour
...Utilization Review Nurse The Utilization Review Nurse gathers demographic... ...treatment, certifies the medical necessity and assigns an appropriate... ...and of CorVel. This is a remote position. Essential... ...concern to the appropriate claims staff/customer Collects data...Remote workClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hoursCorVel
United States4 days ago- ...5f5;}Remedial Pro is a specialized medical billing company serving substance abuse... ...benefits verification, billing and claims submission, and utilization review, we help treatment centers optimize... ...a desk and working on a computer.Remote PositionBenefits:• Competitive...Remote workClaimsHourly payWork at office
$18 - $20 per hour
...Utilization Review Coordinator PRIMARY PURPOSE: To assign utilization review requests; to verify... ...demographics and UR information into claims or clinical management system; maintains... ...required. Customer service in medical field preferred. Workers compensation,...Remote workClaimsWork at officeLocal areaFlexible hoursSedgwick
United States3 days ago- ...are required to address utilization review cases. Roles and... ...monitoring of cases involving medical decisions and quality... ..., reimbursement, and claim denials/appeals.... ...relationship with Medical Director on CM and UM cases. Demonstrates... ...This is a remote position. Our whole company...Remote workClaimsLive inFlexible hoursWeekday work
Evry Healthcare Inc.
Brooklyn, NY5 days ago - ...Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career... ...clinical information to determine the medical necessity, appropriateness, and... ...related activities. Review medical claims and pre-determinations for medical necessity...Remote workClaimsFull timeTemporary workSummer workWork at officeFlexible hours
Cobalt Benefits Group
United States4 days ago $248.5k - $373k
...73,000/yearJob Area: Medical & Clinical OperationsCompany... ...coverage and medical claims reviews. Our role is to... ...costs.The Medical Director provides physician support... ...knowledge in various utilization management activities... ...flexibility to work remotely * from anywhere...Remote workClaimsMinimum wageFull timeWork experience placementLocal area- ## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave... ...requirements. This role reviews medical information submitted by... ...in the office and three days remote. Candidates must also have flexibility... ..., healthcare providers, claims professionals, and internal...Remote workClaimsWork at officeImmediate startFlexible hours2 days per week
Acrisure LLC
Bradenton, FL3 days ago $70.7k - $133.08k
...A Glance Location: Remote Facility: Ascension... ...Thomas Department: Utilization Management Schedule:... ...Comprehensive health coverage: medical, dental, vision,... ...Admissions & Medical Necessity Review: Evaluating service... ..., and managing claim denials or appeals....Remote workClaimsFull timeLocal areaAscension
United States3 days ago- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workClaimsFull time
Innovative Systems Group
Richardson, TX5 days ago - ...(GRC) is hiring a full-time Utilization Review Liaison! In this important administrative... .... This position is fully remote and offers the opportunity... ...contribution toward the medical insurance plan of your... ...changes. Investigate denied claims and assist in efforts to...Remote workClaimsFull timeWork at officeHome office
Gateway Rehabilitation Center
Coraopolis, PA16 days ago - ...Healthcare Utilization Review Specialist Join our team at Company and build a meaningful career in employee benefits solutions. As... ...customized, self-funded insurance programs. You'll review claims for medical necessity, verify authorizations, and collaborate across clinical...Remote workClaimsTemporary workSummer workFlexible hours
Cobalt Benefits Group
United States12 hours ago - ...Department Name: Utilization Mgmt Work Shift:... ...Management Care Reviewer, you will be an important... ...Team. This 100% remote role manages a... ...departments including Claims. The schedule for... ...determine the medical appropriateness of... ...cases to Medical Directors and presents them...Remote workClaimsFull timeMonday to FridayShift work
Banner Health
Phoenix, AZ7 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Director, Claims & Utilization Review. Be the first to apply!
Related searches
- lead clinical data manager Atlanta, GA
- behavioral health manager Atlanta, GA
- medical director Atlanta, GA
- entry level clinical data manager Atlanta, GA
- medicare medical director Atlanta, GA
- health insurance manager Atlanta, GA
- medical operations supervisor Atlanta, GA
- medical director oncology Atlanta, GA
- clinic supervisor Atlanta, GA
- associate director clinical operations Atlanta, GA