Remote Appeals Physician - Clinical Review & Quality
Stryker Corporation
- Remote job
Stryker Corporation is seeking a remote clinical reviewer responsible for adjudicating appeals and grievances for UnitedHealthcare associated companies. The role requires an MD or DO with an active license, alongside board certification in a specialty and significant clinical experience. The ideal candidate will manage case reviews, communicate with medical directors, and contribute to organizational projects, working towards process improvements and quality assurance. #J-18808-Ljbffr Stryker Corporation
$248.5k - $373k
...qualified clinician to handle ongoing clinical review and adjudication of appeals for UnitedHealthcare. The ideal... ...clinical practice and 2 years of quality management experience. This role involves... ...offers flexibility to work remotely and competitive compensation ranging...Remote jobQuality$90.87 - $154.33 per hour
...with us. Job Posting Title Physician Clinical Reviewer - Rheumatology- REMOTE Job Description Job... ...rationale for standard and expedited appeals. Provides assistance and acts... ...Experience with cost benefit analysis, quality assurance and the continuous...Remote workQualityWork experience placementInternshipWork at officeLocal areaVisa sponsorshipWork visa$248.5k - $373k
Wisconsin Psychiatric Association Inc is seeking an Appeals and Grievances Medical Director responsible for the clinical review of appeals and grievances cases for... ...least 5 years of clinical practice and 2 years in Quality Management. The compensation typically ranges...Remote jobQuality- ...healthcare consulting firm is seeking a full-time remote Peer Reviewer (Non-physician) to provide clinical expertise for comprehensive peer reviews. Candidates... ...benefits and a dynamic work environment focused on quality healthcare solutions. #J-18808-Ljbffr Visual Connections...Remote jobQualityFull time
- Physician (MD/DO) - Clinical Review & AI Care Plan Evaluation Project (remote) Remote Overview We are excited to invite experienced clinicians to join us in shaping the... ...planning looks like Collaborate on standardizing quality benchmarks for AI evaluation What This Role...Remote jobQualityHourly payFlexible hours
- ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify acquired Performant and... ...data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare... ...the ability to work independently in remote setting with minimum supervision and...Remote workQualityFlexible hours
$150 per hour
...About the job Remote | Physician Clinical Review Expert - $150-$220/hour We are sharing a specialised part-time consulting opportunity for... ...documentation review, clinical output validation, and high-quality project execution. Selected professionals will apply...Remote workQualityHourly payWeekly payContract workPart timeFor contractorsFlexible hours- ...Clinical Appeals Reviewer (Licensed Healthcare Professional) Fully Remote-United States Job Type Full-time Description Overview Tanaq Support Services... ...workgroups at management's direction. Conducts quality reviews, as needed. Serves as a subject...Remote workQualityFull timeContract workPart timeFor contractorsWork at officeLocal areaNight shift
$90.87 - $154.33 per hour
...with us. Job Posting Title Physician Clinical Reviewer- Pediatric Neurology- REMOTE Job Description Job... ...rationale for standard and expedited appeals. Provides assistance and... ...Experience with cost benefit analysis, quality assurance and the continuous...Remote workQualityWork experience placementInternshipWork at officeLocal areaVisa sponsorshipWork visa- ...Clinical Appeals Review & Compliance Specialist The Clinical Appeals Review & Compliance Specialist... ...: Composure Decision Quality Organizational Agility Problem Solving... ...or other company location (or from a remote location with management approval based...Remote workQualityWork at officeLocal areaMonday to FridayNight shiftWeekend work
- ...DRG Clinical Physician Reviewer We are seeking a highly experienced DRG Clinical... ...team. This is a fully remote opportunity for a physician... ...directly impact healthcare quality and reimbursement integrity... ...reviews, including outlier and appeal cases Collaborate with internal...Remote workQuality
- ...Surgeon Utilization Review Opportunity Dane Street... ...its panel of Physician Reviewers. We are currently... .... This is a fully remote, non-clinical role offering... ...treatment requests and appeals. No patient contact,... ...physicians to ensure high-quality, evidence-based clinical...Remote workQualityPrice workExtra incomeFor contractorsFlexible hours
- ...firm is looking for an independent contractor with expertise in Clinical Genetics to join their telework team. In this role, you will... ...practice experience. Enjoy a flexible schedule while contributing to high-quality healthcare assessments. #J-18808-Ljbffr Dane Street, LLCRemote jobQualityFor contractorsFlexible hours
- ...Can work remotely in any state except CA, NY, HI or AK 20... ...Summary: Evaluates clinical service requests made by an... ...requests. Participates in the Physician Review Units' appeal process of service denials... ...in all unit continuous quality improvement activities....Remote workQualityWeekend work
- ...Job Title External Physician Reviewer Job Type Occasional Category... ...The types of reviews AFMC Clinical Services completes are... ...Mbps uploaded to maintain call quality and process integrity. +15Mbps... ...United States when conducting appeal considerations...Remote workQualityFull timeContract workLocal areaWork from home
- ...Rehabilitation Telecommute Medical Review Stream Physician Location US-CA-... ...JOB SUMMARY: Relying on clinical background, reviews health... ...Director to discuss quality of care and credentialing and... ...appropriate disclaimers and appeal process with the providers....Remote workQualityContract workTemporary workFor contractorsLocal areaMonday to FridayFlexible hours
- A healthcare organization is seeking a Physician Clinical Reviewer for a remote role. The position requires reviewing medical service requests for compliance... ..., interacting with healthcare providers, and ensuring quality documentation. The candidate must have an MD or...Remote jobQuality
- ...Position Overview Remote Description: Evaluates clinical service requests made by an organization... ...requests. Participates in the Physician Review Units' appeal process of service denials. Participates... ...in all unit continuous quality improvement activities. Other duties...Remote workQualityContract workShift workWeekend work
$88.7 - $98.55 per hour
...Health, LLC is seeking a Physician Medical Reviewer (M.D. or D.O.) to join their team remotely. The role involves... ...independent medical service appeal reviews for TennCare,... ...medical testimony and quality assurance.... ...certification, and 5+ years of clinical practice. The...Remote jobQualityHourly pay- ...seeking a high-performing Physician Reviewer to join our Group Health division... ...preauthorization, appeals, DRG clinical validation, benefit review... ...operational teams to ensure quality and compliance Reviews... ...systems Work Environment Remote work from home Full-time,...Remote workQualityFull timeTemporary workWork at officeWork from homeMonday to FridayNight shift
$88.7 - $98.55 per hour
...technology, services, and clinical expertise. Our mission... ...Acentra is looking for a Physician Medical Reviewer (M.D. or D.O.) (Remote U.S. - Preferred within... ...independent medical service appeal reviews for TennCare and... .... Participate in quality assurance activities for...Remote workQualityWork experience placementLocal areaDay shift- ...Medical Reviewer Pay rate is ***/hour fully remote, but must reside in one of our plan... ...OK, MT, TN. Evaluates clinical service requests made... .... Participates in the Physician Review Units' appeal process of service denials... ...all unit continuous quality improvement activities...Remote workQualityMonday to FridayShift workWeekend work
- ...will serve as the clinical strategist, operator... ..., grievance and appeals, clinical contracting... ..., and UM dental review. • Ensure the... ...reports include: VP, Physician Leadership... ...physician review, quality improvement, legal... ...: While this is a remote position, occasional...Remote workQualityApprenticeship
$140 per hour
...About the job Remote | Clinical Reasoning & Medical Review Consultant - $140-$320/hour We are sharing a specialised part-time consulting opportunity... ...specialty-specific healthcare documentation, and high-quality project execution. Selected professionals will apply...Remote workQualityHourly payWeekly payContract workPart timeFor contractorsWork at officeFlexible hours- ...Job Description: Clinical Supervisor, UM Denial... ...Type: Hybrid (85% remote, 15% onsite in... ...in ensuring a high-quality, efficient, and compliant... ..., performance reviews, and disciplinary... ...effectively with physician reviewers, medical... ...prior-authorization, appeals & grievance, or...Remote workQualityPermanent employmentTemporary work
- ...features. Location: Remote (Must reside in IL... ..., board-certified physicians to join their... ...team as Physician Reviewers. In this remote role... ..., you will review clinical service requests,... ...internal teams to ensure quality and cost-effective... ...Review Unit’s appeals process for...Remote workQualityFull timeWeekend work
- ...frontier AI labs to generate high-quality data, evaluations, and... ...dermatologists to contribute senior clinical expertise to data curation... ...groups. This is the senior reviewer track of the project. You will... ...Competitive pay and flexible remote work. Learn how advanced...Remote workQualityContract workFor contractorsFreelanceFlexible hours
$248.5k - $373k
Texas Health Institute is seeking an Appeals and Grievances Medical Director to oversee clinical review for appeals and grievances cases. The role involves detailed... ...by over five years of clinical practice and quality management experience. Competitive compensation...Remote jobQuality- ...Incorporated is looking for a Senior Nurse Reviewer responsible for coordinating clinical charge audits and appeal processes. The role demands strong... ...and experience in clinical nursing and quality assurance. This is a remote position requiring effective communication...Remote jobQuality
$68.57k - $104.84k
...TX is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic... ...(clinical/coding) reviews of medical records and... ...rules. This is a remote position. ESSENTIAL... ...documentation Check for physician's notes supporting... ...director with appeals, rebuttals, etc. Notify...Remote workQualityMinimum wageFull timeWork at officeLocal areaFlexible hours
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