Remote Corporate Medical Director, Grievances & Appeals
Jobleads-US
- Remote job
Humana Inc. is seeking a Corporate Medical Director who will interpret clinical data, review appeals, and make independent, expert determinations across Medicare, Medicaid, and Commercial products.
The role requires leadership, broad knowledge of managed care, and the ability to act as a clinical SME on highly complex cases. The position is fully remote within the United States, with occasional travel for training or meetings.
#J-18808-Ljbffr Jobleads-US$246.1k - $344.2k
...our caring community The Corporate Medical Director relies on medical... ...reviews of medical records for appeals decisions. The Corporate Medical... ...oversee clinical reviews of grievance and appeal cases for... ...specialists Work Style: Fully remote living in the USA....Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work$248.5k - $373k
...$248,500.00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ....Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical...Remote workMinimum wageWork experience placementLocal area$236.5k
Position Purpose:Assist the Chief Medical Director to direct and coordinate the... ...with regulatory, state, corporate, and accreditation... ...clinical teams, network providers, appeals team, medical and pharmacy consultants... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hoursWeekend work- A prominent healthcare organization is seeking an Appeals and Grievances Medical Director to manage clinical reviews of appeals for various health plans. The role offers flexibility to work remotely. Qualified candidates should have an MD or DO, be board certified, and...Remote work
- ...Health Care Service Corporation seeks a Medical Director for a remote, nationwide role. You will oversee assigned portions of medical policies and programs, perform medical appeals reviews, and collaborate with provider communities to improve policy effectiveness....Remote work
- ...Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote workWork from home
$88.7k - $149.43k
The Appeals & Grievances (A&G) Weekend Inventory Manager is responsible for managing and monitoring... ...Communicate and escalate cases to Medical Peer reviewers Maintain delegated vendor... ...such as Microsoft Word and Excel, corporate email and virtual filing systems (ie....Full timeTemporary workWork experience placementLocal areaWeekend work$123.37k - $161.93k
...'re Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team. Oscar is the first... .... Work Location: This is a remote position, open to candidates who reside... ...are eligible for benefits including: medical, dental, and vision benefits, 11 paid...Remote workFull timeWork from homeHome office$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This...Remote workContract workWork at officeMonday to Friday$191.5k - $355.6k
...Remote IL - Chicago Full time R0055458 At HCSC, our employees are the cornerstone... ...is responsible for assigned aspects of medical policies and programs. Performs medical... ...Statement At Health Care Service Corporation, you will be part of an organization committed...Remote workFull timeWork at officeWork from home- ...Grievance And Appeals Coordinator The Grievance and Appeals Coordinator is responsible for processing appeals, grievances, complaints, and... ...and simple language and include elements that satisfy corporate, regulatory, and accreditation timeframes, accuracy and response...Remote work
$191.5k - $355.6k
...is responsible for assigned aspects of medical policies and programs. Performs medical... ...preferred but nt required This is a remote work from home role #LI-MG1 Are you... ...Transparency Statement: At Health Care Service Corporation, you will be part of an organization...Remote workFull timeWork at officeWork from home$262.15k - $393.22k
...Together.The Regional Medical Director, Non-Acute... ...authorization, denial, appeal, and overturn trends;... ...in audits, appeals, grievance reviews, and regulatory... ...requiring a combination of remote work, home-based clinical... ...travel to the corporate office and other organizational...Remote workFull timeWork at officeLocal areaWork from home- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
$83.1k - $120.36k
Position Summary: The Appeals & Grievances (A&G) unit manages... ...This is either a remote or on-site position located... ..., Prior Approval, Medical Necessity, Pre-certification... ...cases for Medical Director Review ensuring that... ...Excel, as well as corporate email and virtual filing...Remote workContract workTemporary workWork experience placementLocal area- ...Job Title: Medical Director – Utilization Management Location: Remote Duration: 6+ Months Contract with possible extension Active medical state... ...appropriateness. Complete initial determinations, appeals, grievances, and other reviews as assigned. Compose...Remote workContract workPrivate practice
- ...Managing and coordinating grievance and appeals processes, the full-time Grievance & Appeals Coordinator will review incoming cases, ensure compliance... ...collaborate with internal teams while working in a hybrid remote environment. Key responsibilities Manage and coordinate...Remote workFull timeWork at office
- ...Job Title: Medical Director – Utilization Management Location: Remote Duration: 6+ Months Contract with possible extension If you want to know about... .... Complete initial determinations, appeals, grievances, and other reviews as assigned. Compose clear...Remote workContract workPrivate practice
- ...About The Role The Medical Director performs utilization review and medical... ...assignment. *This is a Remote Role Primary... ...rationale that is defensible on appeal, external review, and audit.... ...input on member and provider grievances and reviews complaint resolution...Remote workWork at officeLocal areaFlexible hours
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHourly payFull time- ...full life cycle of member and provider appeals and grievance cases, the full-time Appeals and... ...ensure timely resolution while working remotely. Key responsibilities Research and analyze... .../appeals coordination Knowledge of medical terminology, benefit interpretation, and...Remote workFull timeWork at office
$290k - $350k
...), we provide comprehensive medical care along with support for... ...Scope: The Medical Director is the senior clinical... ...PACE regulations; oversees grievances, appeals, CLIA-waived onsite lab compliance... ...administrative, community, or remote environments, depending on...Remote workContract workTemporary workFor contractorsFixed term contractWork at officeLocal areaWork from homeFlexible hours$215k - $408.5k
...clinical professional on our Medical Management/Health... ...: Full time Medical Director for our Health Plan in... ...Hampshire Centene Corporation is a leading provider... ...teams, network providers, appeals team, medical and... ...approach to work with remote, hybrid, field or office...Remote workFull timePart timeWork at officeFlexible hoursWeekend work- ...Ability to work independently and manage multiple priorities in a remote setting.\n- Understands state and federal requirements\n-... ...Job Description An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving...Remote workWork at office
$195.2k - $341.6k
...Medical Director The Medical Director is responsible for supporting staff by providing training... ...Provide physician review for clinical appeals cases Participate in the evaluation... ...of the Quality Improvement Plan and corporate level quality initiatives Collaborate...Remote workHourly payWork at officeWeekend workAfternoon shift$221.3k - $420.5k
...Remote Medical Director - South Carolina Join to apply for the Remote Medical Director - South... ...in accordance with regulatory, state, corporate, and accreditation requirements. Assists... ...clinical teams, network providers, appeals team, medical and pharmacy consultants...Remote workFull timeWork at officeFlexible hoursWeekend work$170 per hour
...Medical Director Req number: R8700 Employment type: Full time Worksite flexibility: Remote Who we are CAI is a global services firm with over 9,000 associates... ...determination of cases, review of appeals and grievances, and other reviews as assigned...Remote workHourly payFull timeApprenticeshipPrivate practiceWork at officeLocal areaWorldwide$227.6k
...incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and... ...appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise...Remote workFor contractorsPrivate practiceWork at officeLocal area- ...Objectives: Under the direction of the Senior Medical Director, the Medical Director will lead and participate in the Maryland... ...report quality of care issues. Participate in MPC/MCO Grievance and Appeals Review Processes. Participate in the QM/UM Committee,...Remote workFull timeTemporary workWork experience placementWork at officeLocal area
$225k - $300k
100% Remote, Medical Director Job Title: Physician-CW - Medical Director-CW Estimated full-time salary ranges from $225K-$300... ...Utilization Management experience Medical Necessity Reviews, Appeals & Grievances Peer-to-Peer experience MCG/InterQual preferred...Remote workFull timeContract workPrivate practiceFlexible hours
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