Remote Medical Director - Medicare & Compliance
Humana
Humana, Inc. seeks a Medical Director to review and determine medical necessity for Medicare/Medicaid services, aligning with CMS guidance, Humana policies, and clinical standards. The role requires strong regulatory interpretation and ongoing credentialing, with work conducted under OneHome governance. Responsibilities include evaluating services, ensuring compliance, and contributing to an engaged team culture. Remote work is available with defined hours and travel as needed. #J-18808-Ljbffr
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote Medical Director - Medicare & Compliance in Salem, OR vacancy
- ...Humana is seeking a Medical Director to review and determine medical necessity for Medicare and Medicaid services, ensuring alignment with CMS guidelines and Humana... ...working within OneHome framework. The position is remote, full-time, and includes 40-hour weeks with...Remote workFull time
Humana
United States2 days ago - ...Virtix Health LLC is seeking a board-certified Medical Director to oversee Medicare clinical services, ensuring CMS compliance and driving care delivery improvements. After... ..., discuss cases, and guide clinical teams remotely. Collaborating with multidisciplinary teams...Remote work
Virtix Health LLC
United States1 day ago - ...UnitedHealth Group’s Optum division seeks a Medical Director to lead the Focus Claims Review program, guiding medical services and policies... ...for claim reviews and provider interactions. The role supports remote work nationwide in the U.S. and requires ABMS/AOA ENT...Remote work
UnitedHealth Group
United States1 day ago - ...Virtix Health is seeking a highly skilled Medical Director to join our remote team. The role focuses on assessing the quality of clinical services for Medicare beneficiaries, ensuring CMS compliance, and driving improvements in care delivery. The position requires...Remote work
Virtix Health LLC
United States3 days ago $216.11k - $283.64k
...we're Oscar. We're hiring an Associate Medical Director, Regulatory Management to join our Clinical... ...policy guidance, ensures enterprise compliance with NCQA, CMS, state, and... ...Work Location: This position is fully remote and open to candidates residing in the...Remote workFull timeWork at officeWork from homeHome office- ...Diagnostics seeks a part-time Clinical Director in Tampa, FL. This remote consulting role requires an MD or DO... ...testing experience. You will review medical policies, discuss clinical decisions... ...allows remote work while supporting compliance and clinical standards. #J-18808-...Remote workPart time
ADP
United States13 hours ago - ...AccentCare is seeking an Executive Director for Hospice in Washington, DC. This full-time... ...oversees clinical operations, regulatory compliance, and program growth for the Washington... ...area. On-site work is required, with no remote option, to lead a dedicated care team...Remote workFull time
AccentCare
Washington DC3 days ago $223.8k - $313.1k
...of our caring community The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing... ...a framework of regulatory compliance. This secures compliance with all... ...Additional Information Workstyle: Remote work at home Hours: Must be...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayHumana
Trenton, NJ3 hours ago- ...Jobgether is seeking a National Medical Director based in the United States to lead clinical strategy and drive measurable Medicare outcomes in a fully remote, leadership capacity. You will own clinical performance across the patient population, focusing on preventing...Remote work
Jobgether
United States3 days ago - ...Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to lead utilization management for Medicare populations. The role reports to the Senior VP of Clinical Operations and collaborates with Quality and Provider Relations to optimize care and approvals...Remote workWeekend work
Alignment Healthcare USA, LLC in
United States2 days ago - ...Humana is seeking a Medical Director to perform medical interpretation and determinations for services in inpatient or post-acute settings... ...mentored training transitioning to independent work. Fully remote position with occasional travel to Humana offices for training...Remote work
Humana
United States1 day ago $223.8k - $313.1k
...part of our caring community The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The... ...a context of regulatory compliance and work is assisted by diverse... ...information. Travel: While this is a remote position, occasional travel to...Remote workBi-weekly payFull timeTemporary workWork at officeLocal areaWork from homeHome officeHumana
Dover, DE13 hours ago- ...Hospice of Southern Illinois in Glen Carbon, IL is seeking a Medical Director to provide qualified medical direction and consultation for hospice... ...care, supervise hospice physicians, and ensure adherence to Medicare COP, CHAP, and state regulations. Responsibilities include...
Graham Healthcare Group
Glen Carbon, IL4 days ago $223.8k - $313.1k
...community Please note that this Medical Director position is a part-time,... ...expertise to review Medicare drug appeals (Part D and B).... ...within a context of regulatory compliance and work is assisted by diverse... ...Travel: While this is a remote position, occasional travel...Remote workBi-weekly payHourly payDaily paidFull timePart timeApprenticeshipSeasonal workWork at officeLocal areaWork from homeHome officeFlexible hoursHumana
Denver, CO2 days ago$223.8k - $313.1k
...our caring community The Medical Director relies on medical background... ...management or inpatient review (Medicare Advantage, Managed Medicaid,... ...Director. Work Style: Remote in the contiguous US, may... ...take affirmative action, in compliance with Section 503 of the Rehabilitation...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work- ...Location: Remote (U.S.-based) Commitment: Full-time Type: W-2 employee About MiraMace... ...-backed company on a mission to help Medicare patients navigate a complicated... ...need. About the Role As National Medical Director, you own clinical outcomes for every Mira...Remote workFull time
- ...Clover Health is seeking a Medical Director, Utilization Management, to lead evaluation of outpatient referrals and inpatient admissions for medical appropriateness. The physician will apply Medicare Coverage Determinations and Clover policies to determine medical necessity...Remote work
Clover Health
United States4 days ago $174.07k - $374.92k
...CVS Health Medical DirectorWe're building a world of health... ...care resources.This is a remote based (work at home)... ...Responsibilities of this Medical Director role are related to Medicare Appeals:Direct daily work... ...Medicare Quality and Compliance on an ongoing basisDevelop...Remote workHourly payFull timeTemporary workWork from homeWeekend workOak St. Health
Windsor Locks, CT5 days ago$190k - $210k
...strategic, and hands-on Associate Director/Sr. Manager, Clinical Compliance Specialist to support and maintain... ...chapter. This position is open to remote or hybrid (Boston) candidates.... ...in pharmaceutical, biotechnology, medical device, or CRO environments....Remote workFull time- ...through its Aetna subsidiary, seeks an experienced Medical Director to lead Medicare Appeals. This remote role can be based anywhere in the United States and... ..., monitor opportunities, and collaborate with Medicare Quality and Compliance to advance policy #J-18808-LjbffrRemote work
CVS Health
United States3 days ago - ...Leading compliance oversight in a remote capacity, the full-time Manager of Revenue Cycle & Compliance will manage audits, analyze data, investigate... ...compliance investigations and coordinate responses to Medicare and commercial payer audits, ensuring documentation quality...Remote workFull time
Virtual Vocations Inc
United States1 day ago - ...Elevance Health is seeking a Medical Director for Florida Medicare to oversee utilization management, clinical reviews, and cost-of-care initiatives.... ...Medicare timelines, including weekend coverage. Hybrid-remote work with in-person trainings is expected, preference for...Remote work
Elevance Health, Inc.
Tampa, FL3 days ago - ...Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D & B) leveraging broad clinical expertise. You will analyze complex cases, collaborate with clinicians, and support CMS audits to ensure value-based care within Medicare rules. Responsibilities...Remote work
Humana
Jackson, MS13 hours ago - ...Humana Inc. is seeking a Medical Director to provide expert clinical review of Medicare drug appeals (Part D & B) and support value-based care within Humana policies... ...ensure optimal member care, balancing regulatory compliance with Humana policy, using CMS guidelines and...Remote work
Humana, Inc.
Nashville, TN1 day ago - ...Humana, Inc. seeks a Medical Director to review Medicare drug appeals (Part D & B) with broad clinical expertise. The role involves case-by-case... ...optimal patient outcomes while maintaining regulatory compliance. Responsibilities include peer discussions, CMS audit support...Remote work
Humana
Bismarck, ND5 days ago - ...Humana Inc. is seeking a Medical Director to review Medicare drug appeals (Part D and B) and ensure medical necessity aligns with Humana policies... ...support value-based care while maintaining regulatory compliance. The position requires an MD or DO, board certification...Remote work
Humana
Albany, NY4 days ago $206.01k
...Purpose The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff... ...revising medical policies to ensure compliance and support Medicare coverage decisions... ...40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our...Remote workFull timeFor contractorsWork experience placementWork at officeLocal areaMonday to Friday033 Palmetto GBA
South Carolina3 days ago- ...Humana Inc. is seeking a Medical Director for a fully remote role to oversee medical determinations with an emphasis on Medicare Advantage and related care management. You will interpret clinical data, ensure alignment with national guidelines, and collaborate with...Remote work
Humana
Columbus, OH3 days ago - ...Humana Inc. is seeking a Medical Director to provide Medicare drug appeals review and medical necessity assessments. The... ...-functional collaboration, and ensuring compliance with Medicare and Humana policies. You will work remotely with occasional travel to Humana offices...Remote work
Humana
Columbus, OH13 hours ago $215k - $408.5k
...We’re Hiring: Full time Medical Director Centene Corporation is a leading provider of government... ...high-quality services to Medicaid and Medicare members, as well as to individuals and... ..., and a flexible approach to work with remote, hybrid, field or office work schedules...Remote workFull timePart timeWork at officeFlexible hoursWeekend work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Director - Medicare & Compliance. Be the first to apply!
Related searches
- behavioral health manager Salem, OR
- medical insurance manager Salem, OR
- medical sales manager Salem, OR
- senior director clinical operations Salem, OR
- director of health information management Salem, OR
- clinical services director Salem, OR
- health services director Salem, OR
- occupational health manager Salem, OR
- public health director Salem, OR
- urgent care medical director Salem, OR