Remote Medical Director, Utilization Management

A leading health insurance organization is seeking a Medical Director. This role involves utilizing your medical expertise to assess healthcare services and ensure compliance with regulations. You will work collaboratively with internal teams and external healthcare providers, and participate in utilization management. Candidates should have an MD or DO...

A leading healthcare organization seeks a Medical Director to support clinical review processes and enhance health outcomes. The position requires an M.D. or D.O., active medical license, and board certification. You will collaborate with healthcare teams to ensure efficient service delivery and cost-effective care. The role offers flexible remote work...

Medical DirectorBecome a part of our caring community and help us put health first. The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director...

Regional Medical Scientific Senior Director Team LeadThe Regional Medical Scientific Senior Director Team Lead, RMSD TL, is a credentialed therapeutic and disease expert whose primary role is the leadership, management, and accountability of a field-based team of RMSDs and their deliverables. The RMSD TL ensures team members adhere to company policies and...

Practice ManagerThis position will be fully remote and can be hired anywhere in the continental U.S. The Practice Manager is a key leadership role within our Services consulting division, responsible for the technical leadership and personnel management of the Firewall practice. This individual will ensure that methodologies and service delivery processes...

Schedule: Monday to Friday - Eastern TimeLocation: RemoteAbout the RoleAs a Registered Nurse you will make an impact by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials...

Job Opportunity at Optum Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by...

A national healthcare organization in Honolulu seeks a Medical Director with an MD or DO. The role requires 5+ years of clinical experience, focusing on Medicare services. Responsibilities include medical interpretations, collaborating with teams, and ensuring compliance with clinical standards. The ideal candidate will communicate effectively, engage with...

Project ManagerGovCIO is currently hiring for a Project Manager to support the Health Services Portfolio Veterans Health Services Finance product line within the Department of Veterans Affairs (VA) Office of Information and Technology (OIT). The Project Manager will be a hands-on leader who will support a VA Product Manager with day-to-day oversight...

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require...