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Humana

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Medical Director - Inpatient Review
Seen active today Posted Aug 15
Remote Remote United States Senior Full Time $223.8k-313.1k/yr

Role highlights

  • Role Overview Perform expert clinical review of inpatient medical records, assessing medical necessity based on national guidelines, CMS re…
  • Join a distinguished team of physicians dedicated to advancing the quality of inpatient care through clinical expertise and thoughtful medi…

Centene Corporation

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Remote Medical Director, Inpatient Medicare
Seen active today Posted Aug 14
Remote Remote United States Senior Full Time

Role highlights

  • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulato…
  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.

Centene Corporation

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Remote Inpatient Medicare Medical Director
Seen active today Posted Aug 14
Remote Remote United States Senior Full Time $236.5k-449.3k/yr

Role highlights

  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
  • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulato…

Oscar Health

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Physician Reviewer - Utilization Management
Seen active yesterday Posted Aug 8
Remote Remote United States Mid

Role highlights

  • We're hiring a Physician Reviewer to join our Utilization Management team.
  • Hours: 8am - 5pm in your local time zone Call rotation - 1 weekend every 16 weeks You will report…

Evolent Specialty Services, Inc

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Radiation Oncology Field Medical Director
Seen active yesterday Posted Aug 6
Remote Remote United States Senior Full Time $130-145/hr

Role highlights

  • What You’ll Be Doing: Field Medical Director, Radiation Oncology As a FMD, you will be a key member of the…
  • What You Will Be Doing: Serve as the Physician match reviewer in Radiation Oncology and imaging cases, that do not…

Altais Health Solutions

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UM Medical Director - Casual
Seen active yesterday Posted Aug 3
Remote Remote United States Senior Full Time $222.8k-267.3k/yr

Role highlights

  • Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicians with regard to…
  • The Medical Director will provide cooperative leadership and direction to the UMC (Utilization Management Committee) Primary Care Physician…

Dane Street, LLC

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Board Certified Physician Reviewer - General Surgery (Colorado License)
Seen active today Posted Jul 29
Remote Remote United States Mid Contract

Role highlights

  • Requirements Current, unrestricted Colorado Medical License Active Practice Board Certified Benefits Independent consultant role allows for…
  • We are looking for the specialties listed below with active Colorado License to address the medical necessity of treatment requests…

Evolent Specialty Services, Inc

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Otolaryngologist-Physician Reviewer-Radiology (Full-Time)
Seen active yesterday Posted Jul 27
Remote Remote United States Entry Full Time $95-109/hr

Role highlights

  • What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the…
  • What You’ll Be Doing: Currently seeking Otolaryngologist Physicians to join our Radiology department As an FMD, Radiology you will be…

Dane Street, LLC

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Board Certified Physician Reviewer - Neurological Surgery (Texas...
Seen active today Posted Jul 21
Remote Remote United States Mid Contract

Role highlights

  • Requirements Current, unrestricted Texas Medical License Active Practice Board Certified in Neurological Surgery Benefits Independent consu…
  • We are looking for the specialties listed below with active Texas License to address the medical necessity of treatment requests…

Dane Street, LLC

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Board Certified Physician Reviewer - PM&R/Pain Management...
Seen active today Posted Jul 21
Remote Remote United States Mid Contract

Role highlights

  • Requirements Current, unrestricted Connecticut Medical License Active Practice Board Certified in PM&R/Pain Management Benefits Independent…
  • We are looking for the specialties listed below with active Connecticut License to address the medical necessity of treatment requests…

The Cigna Group

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Medical Director - Pathology - EviCore
Seen active today Posted Jul 21
Remote Remote United States Senior Full Time

Role highlights

  • As a Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll leverage your…
  • Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision mak…

Evolent Specialty Services, Inc

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(Orthopedic Surgery) Field Medical Director, MSK Surgery
Seen active yesterday Posted Jul 19
Remote Remote United States Senior Part Time $135-150/hr

Role highlights

  • What You Will Be Doing: Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases, that do not initially meet…
  • MD/DO/MBBS A clinical license, active and in good standing, in your home state is required Minimum of five (5) years’…

E2E Alignment Healthcare USA, LLC

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Medical Director, Utilization Management
Seen active 2 days ago Posted May 1
Remote Remote United States Senior Full Time

Role highlights

  • Through remote access to our web-based Portal, UM Medical Director/Physician Advisors will complete clinical reviews for medical necessity,…
  • The UM Medical Director/Physician Advisor works with UM licensed staff, Regional Medical Officers and Extensivists to develop and implement…

Thermo Fisher Scientific

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Medical Director/Sr Medical Director - Neurology(Remote U.S)
Seen active today Posted Apr 23
Remote Remote United States Senior Full Time

Role highlights

  • For Senior Medical Director: MD or equivalent required.
  • Knowledge, Skills, Abilities: Therapeutic expertise across one or more medical specialty or sub-specialties Strong decision-making, problem…

Highmark Health

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Medical Director
Seen active today Posted Aug 10
Remote Remote United States Senior Full Time $227.6k/yr

Role highlights

  • Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES…
  • Actively manage projects and/or participate on project teams that require a physician subject matter expert.

More roles at Highmark Health

Centene Corporation

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Medical Director
Seen active today Posted Jul 24
Remote Remote United States Senior Full Time $236.5k-449.3k/yr

Role highlights

  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
  • Qualifications for this role include: MD or DO without restrictions Board Certified Physician Must be licensed in Florida Florida Resident…

More roles at Centene Corporation

Fresh Clinics

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Medical Director
Seen active today Posted May 5
Remote Remote United States Senior

Role highlights

  • In this role, you will provide medical governance and oversight for multiple practices and providers across the country , operating…
  • What you'll do This is a remote-first, high-execution role designed for a physician who can provide clinical agility across a…

Humana

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Medical Director - OneHome
Seen active 3 days ago Posted Jul 8
Remote Remote United States Senior Full Time $223.8k-313.1k/yr

Role highlights

  • Medical Director - OneHome Become a part of our caring community The Medical Director relies on fundamentals of CMS Medicare…
  • Medical Directors review clinical cases for Medicare and Medicaid members, report to the Lead Medical Director, and work within defined…

CareSource

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Medical Director (REMOTE Appeals Medical Director - Pacific Standard...
Seen active today Posted Mar 23
Remote Remote United States Senior Full Time

Role highlights

  • Essential Functions: Provide prior authorization medical reviews, consultation and clinical review services Participate in peer-to-peer dis…
  • Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - D…

Broadway Ventures

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Medical Claim Reviewer (CGS, DMEC)
Seen active yesterday Posted Mar 27
Remote Remote United States Mid $65k/yr

Role highlights

  • This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines.
  • Key Responsibilities Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.

HFMS HF Management Services, LLC

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Medical Peer Reviewer
Seen active yesterday Posted Mar 26
Remote Remote United States Intern Part Time $122.9k-188k

Role highlights

  • Duties/Responsibilities: The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical reco…
  • Job Profile Summary A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in…

Gainwell Technologies LLC

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Nurse Reviewer (Registered Nurse) - Remote
Seen active today Posted Aug 18
Remote Remote United States Entry $78k-88k/yr

Role highlights

  • Summary We are seeking a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine whether medical…
  • This role involves accessing proprietary systems to review medical records, accurately documenting findings, and providing policy and regul…

Allara

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Endocrinologist - IMLC License | Flexible 1099 Remote
Seen active today Posted Aug 10
Remote Remote United States Mid Contract

Role highlights

  • IMLC license: Active IMLC license or be actively in the process of obtaining one - Clinical Independence: Proven ability to…
  • Fully remote within the U.S. Your Impact - Conduct thorough patient assessments and develop personalized treatment plans via video visits…

Chenega Corporation

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Physician
Seen active today Posted Jul 24
Remote Remote United States Mid Temporary $150/hr

Role highlights

  • Remote Responsibilities Serve as a Contract Medical Reviewer (CMR) who writes medical eligibility determination recommendations via a medic…
  • Work closely with the Team Lead, physicians, and nurse practitioners.

Verse Medical

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Medical Review Nurse
Seen active yesterday Posted Jul 9
Remote Remote United States Mid Full Time

Role highlights

  • As Medical Reviewer, you'll be shaping the future of at-home care.
  • Core Skills & Experience: 3-5+ years medical‑review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian,…
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