Average salary: $234,742 /yearly
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$275k - $300k
...5,000-$300,000) Full benefits: health, vision, dental, vacation, CME, PTO Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license ASAPstart date Sacramento is the state's capital andhas over 450...SuggestedPermanent employmentFull timeRemote workWork from homeMonday to FridayIntegrity Healthcare
Sacramento, CA3 days ago- ...Part-Time | Remote (U.S. Based) Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering... ...evidence-based solutions for more than Physician Advisor (Utilization Review) Part-Time |...SuggestedPart timeWork at officeRemote workWork from home10 hours per weekFlexible hoursShift workWeekend work
Medical Review Institute
Salt Lake City, UT1 day ago - ...to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality... ...the exam room for all patients. What You’ll Be Doing Utilization Review & Clinical Determinations Complete timely review of healthcare...SuggestedBi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home
Guidehealth
Peoria, IL1 day ago - ...A leading healthcare organization is seeking a dedicated Physician Advisor to join their Utilization Review team. This full-time role involves conducting medical necessity reviews, managing denials, and collaborating with healthcare staff to ensure documentation compliance...SuggestedFull timeRemote work
Inova Health System
Fairfax, VA1 day ago $174.07k - $374.92k
...bigger - helping to simplify health care one person, one family and one community at a time. Role Description The Utilization Management Physician Reviewer ensures timely and clinically sound coverage determinations for inpatient and outpatient services using evidence-based...SuggestedHourly payFull timeLocal areaFlexible hoursWeekend workHispanic Alliance for Career Enhancement
Chicago, IL4 days ago- ...Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-... ...Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical...SuggestedPrice workExtra incomeFor contractorsRemote workFlexible hours
Dane Street
United States1 day ago $90.87 - $154.33 per hour
...A healthcare organization seeks a Physician Clinical Reviewer in Gastroenterology to provide medical review for service requests remotely. Candidates... ...to impact patient care and work collaboratively in a utilization management team while enjoying a competitive salary...SuggestedRemote workPrime Therapeutics
Saint Paul, MN1 day ago- ...Physician Reviewer – Utilization Management (Remote)-Full Time Overview We are seeking a Board-Certified Physician to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and...SuggestedFull timeLocal areaRemote workWeekend work
Medix
New York, NY2 hours agonew $43.29 - $76.06 per hour
...assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation of interventions,... ...diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and...SuggestedMinimum wageFull timeLocal areaRelocationRelocation packageShift workDay shift1 day per week- ...Management/Health Services team. The ideal candidate must hold an RN or LPN/LVN compact license and have experience in clinical reviews and utilization management. Responsibilities include drafting clinical correspondence, investigating denials, and collaborating with...SuggestedRemote workFlexible hours
Centene Corporation
Columbia, SC2 days ago - ...care system in California. The Medical Director, Utilization Management - will report to the Sr. Medical Director... ...you will deliver and collaborate on clinical review activities, which includes management of the physician processes in support of utilization management and...SuggestedFull timeWork at office
Blue Shield of CA
Rancho Cordova, CA2 hours agonew - ...is seeking an experienced Medical Director to conduct clinical reviews and guide decision-making in inpatient care. The role... ...of clinical experience, with a focus on hospital medicine and utilization review. Join a distinguished team to impact patient outcomes while...SuggestedRemote work
Humana
Columbus, OH1 day ago $223.8k - $313.1k
...Director relies on medical background and reviews health claims. The Medical Director... ...factors. Join a collaborative team of physicians who bring clinical expertise to medical... ...Physicians, and Physicians with Inpatient or Utilization Review Experience Role Overview Provide...SuggestedFull timeTemporary workApprenticeshipRemote workMonday to FridayFlexible hoursShift workWeekend workHumana
Augusta, ME18 hours ago$223.8k - $313.1k
...organization is seeking a Medical Director in Jefferson City, Missouri. The role involves conducting clinical reviews of inpatient records and making utilization management determinations. Candidates should possess an MD or DO, an active medical license, and at least 5...SuggestedRemote workHumana
Jefferson City, MO1 day ago- ...A healthcare organization is seeking Board-Certified physicians in Oncology for a flexible, remote utilization review role. This position requires a Medical Degree (MD or DO) with a current license in Florida, Minnesota, or Oregon, and an active Board Certification in...SuggestedRemote workFlexible hours
Medical Review Institute
Dallas, TX1 day ago $250k
...A national healthcare solutions provider is seeking a Utilization Review Medical Director to conduct clinical reviews of Durable Medical Equipment requests. This full-time role emphasizes adherence to workflow timelines and requires an MD or DO degree along with board...Full timeRemote workIntegra Partners
Troy, MI1 day ago- ...Director to conduct inpatient medical necessity reviews while collaborating with healthcare providers. This role requires a physician with at least 5 years of post-residency... ...performing clinical reviews, providing utilization management determinations, and ensuring compliance...Remote workMonday to Friday
Humana, Inc.
Nashville, TN1 day ago - ...A health insurance startup is looking for an experienced Medical Director to oversee utilization reviews and prior authorizations. This remote position demands a strong clinical background with a doctorate in medicine and board certification. The ideal candidate will have...Remote workFlexible hours
VALID8 Financial
Austin, TX4 days ago $211.2k - $277.2k
...Physician Reviewer - Utilization Management You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours: 8am - 5pm in your local time zone. Call rotation...Full timeLocal areaRemote workWork from homeHome officeWeekend work- ...Utilization Review Medical Director - Remote Medical Review Institute of America (MRIoA) is a market leader in utilization management and... ...solutions. We are seeking a full‑time, remote Medical Director (Physician Reviewer) to evaluate clinical service requests and...Full timePart timeRemote workShift workWeekend work
Medical Review Institute
Los Angeles, CA1 day ago - ...A leading healthcare company in Washington, D.C. is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency...Remote work
Humana
Washington DC1 day ago - ...A growing healthcare company is seeking an entry-level Utilization Review Nurse for a fully remote position. Responsibilities include performing clinical reviews, assisting in quality improvement projects, and interacting with healthcare providers. Candidates must have...Remote work
TurningPoint Healthcare Solutions
Florida, NY1 day ago - ...The Utilization Review (UR) Clinical Lead is responsible for overseeing and guiding the utilization review process to ensure medical necessity, regulatory compliance, and appropriate use of healthcare resources. This role provides clinical leadership to the UR team, supports...Local area
Hurc LLC
Short Hills, NJ2 days ago - ...Utilization Review Nurse The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the... ...Hospitals' utilization review standard. Under the direction of a physician member of the Utilization Review Committee, the incumbent is...Shift workNight shiftAfternoon shift
County of Los Angeles
Los Angeles, CA2 hours agonew $223.8k - $313.1k
...company is seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes... ...abilities. Join a dedicated team focused on effective utilization management while enjoying a competitive compensation range of...Remote workHumana
Springfield, IL1 day ago- ...The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization... ...activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician...Work experience placement
- ...A healthcare management company in Concord, NH, seeks a Clinical Reviewer, Nurse to join their utilization management team. This role involves evaluating authorization cases, analyzing clinical records, and ensuring quality of care. Required qualifications include a current...Flexible hours
Evolent
Concord, NH1 day ago - ...JOB SUMMARY: Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures... ...requirements. Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services...Local area
Macpower Digital Assets Edge
San Diego, CA18 hours ago - ...Post-Procedure Utilization Management (UM) Registered Nurse The Post-Procedure UM RN is responsible for performing real-time utilization review for surgical and procedural patients immediately following procedures. This role ensures accurate patient status determination...Immediate startNight shift
Cedars-Sinai
Los Angeles, CA2 days ago - ...institutional care to community living. As a Nurse Case Manager Utilization RN I, the successful candidate will suppport the goals of the... ...May Apply This position, Nurse Case Manager Utilization Review Nurse I - Limited Service (Job Requisition #54762) , is open...Work at officeFlexible hours
State of Vermont
Waterbury Center, VT3 days ago
