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Job Posting: Medical Director – Utilization Management (Remote) Position: Medical Director – Utilization Management Location: Remote (Anywhere in the US) Employment Type: 1099 Contract Hours: Full-Time, 40 hours/week Meaningful Payer-Side Impact: Work directly within a major national health plan, influencing decisions that impact member care quality, compliance, and operational strateg • y.Stable Full-Time Hours: Enjoy a fully remote, 40-hour work week that offers the professional autonomy and structural balance many physicians look for when transitioning to payer-side role, • s.Seamless Integration: Step into an established, well-oiled UM operation where your existing expertise is highly valued, featuring a streamlined 2-day training block to get you up to spee d.Key Responsibiliti esAs a Medical Director, you will provide clinical expertise and guidance on complex cases, ensuring high-quality, compliant review processe • s.Conduct utilization management reviews for medical necessity, appropriateness of care, and efficiency across commercial inpatient and outpatient service, • s.Review escalated cases utilizing established medical policy criteria and guidelines (e.g., MCG, InterQual, • ).Conduct peer-to-peer discussions with attending physicians and providers as neede, • d.Support appeals, grievances, and prior authorization review workflow, • s.Maintain a high-volume, efficient workflow, comfortably managing a production target of approximately 55+ cases per 8-hour da, • y.Ensure strict compliance with NCQA, CMS, URAC, and all applicable state and federal regulatory standard, • s.Collaborate cross-functionally with operational and clinical leadership team s.Position Requiremen ts### 🚨 ABSOLUTE MUST-HAVE REQUIREMENT: Candidates must possess direct health plan/payer-side utilization management experience. Hospital-only case management or health system review experience will not be considered for this rol e.Required Qualificatio • nsDegree: MD or DO from an accredited institutio, • n.Certification: Active Board Certificatio, • n.Licensure: Active, unrestricted medical license. Must hold a current license in at least one of the following states: New York (NY), Pennsylvania (PA), or West Virginia (WV, • ).Experience: Multiple years of dedicated payer-side/health insurance utilization management experience working specifically as a Medical Director or Physician Reviewe, • r.Systems: Experience working within managed care workflows, utilizing production queues, EMR platforms (Epic preferred), and strict turnaround time (TAT) metric, • s.Work Style: Ability to work completely independently and productively in a fast-paced, remote production environmen t.Preferred Experien • ceExperience supporting Medicare Advantage and/or Commercial lines of busines, • s.Multi-state medical licensur, • e.Prior experience heavily focused on prior authorizations, appeals, and grievance s.

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25 / hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You

We're currently looking for individuals across the country to take part in remote paid market research, including online focus groups, product trials, and consumer studies.Earn up to $750 a week in your free time by providing feedback on everyday products and services.If you're comfortable sharing y

Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the career for you! State Farm agents market only State Farm insurance and financial service products.Establish customer r

Customer Service Representative.The Customer Service Representative handles customer service requests, appointment booking, customer questions, complaints, and billing inquiries with the highest degree of courtesy and professionalism to resolve customer issues with one-call resolution.The Customer S

Customer Service Representative.Are you a people person? Do you love helping others? U-Haul is in search of friendly, motivated people for the position of Customer Service Representative.As a Customer Service Representative, you will work as part of a supportive team to be the face of U-Haul company

At Drybar, our philosophy is simple: Focus on one thing and be the best at it.Our tagline says it all: No cuts.Drybar Receptionists Also Enjoy These Perks:.Competitive hourly wages beginning at $16.AND get up to $10 for every membership you sell.Medical, Dental & Vision Benefits for ALL employees.Ac

We are looking for a Customer Relations Specialist to support clients with travel planning and booking services.In this role, you will assist clients in exploring travel options, coordinating reservations, and ensuring a smooth and positive experience from initial inquiry through final booking.This

We are a very busy office and are looking for our next great team member.This busy insurance and financial services office has a passion to make a difference in the lives of others and better the community.We are a growing agency with big dreams and lots of potential.Our team works hard to reach our

Customer Service Representative.Location: Bronx, NY 10458 Duration: 12 Months Contract Position.Responds to calls and inquiries from families reaching out to FWCs for support by setting up appointments and/or completing requests for assistance, including follow up and documenting in FWC systems.Unde

Customer Service Inbound, Billing & Customer Support Calls Telemarketing Experience Preferred Job ID# A1001 Leverage your customer service expertise and provide billing support to a Company's customers, all from the comfort of your own home! About Stride 2 Hire works with our Premier partner, Parkes

Customer Service Representative.This is a temporary remote position.Candidates who are selected should be prepared to travel to the PW office in the future when directed.If the distance candidates would have to commute is more than one hour, we will not consider them for the role.We are mainly focus

Hiring Now: Customer Service Representative.We are seeking an experienced Customer Service Representative to support our Transportation and Operations teams in a fast-paced call center environment.Weekends required (included in 5-day workweek).Two days off during the week Weekend availability is man

Customer Service Representative.Our growing organization is looking for a skilled problem solver to join our team as a Customer Service Representative.We need an enthusiastic individual who can listen to customer service issues and then offer a unique and innovative solution to each problem.The succ

Dollar Express Customer Service Representative.As a Dollar Express Customer Service Representative you will be responsible for providing exceptional service to our customers.Key priorities include greeting customers, assisting them with selection of merchandise, completing transactions, and answerin

Customer Service Representative - State Farm Agent Team Member.Hector Camilo - State Farm Agent, a leader in the insurance industry, is actively seeking talented and bilingual individuals to join our team.If you are fluent in both Spanish & English, and passionate about providing exceptional service

Customer Service Representative.Location: GLEN HEAD, NY, 11545.Successful State Farm Agent is seeking a qualified professional to join their winning team for the role of Customer Service Representative - State Farm Agent Team Member.Insurance experience not required we will train the right person wi

We are a growing agency with big dreams and lots of potential.Our team works hard to reach our goals together as a team and have fun while we are doing it! We take pride in using our years of valuable experience to mentor individual team members and prepare them for successful careers.If you want to

Customer Service Representative.Car Wash Customer Service Representative.Location: 1672 Rt 9 Clifton Park, NY (located adjacent to Spare Time).Schedule: 2-3 weeknights (4pm-9pm) & weekends.About Us Hoffman Car Wash is a fast-growing car wash dedicated to providing excellent service and an outstandin

Duties: First point of contact for all customer service issues.Responsible for ensuring patient/client medications, supplies and equipment are accurately recorded and sent to distribution.Consults with Supervisors to ensure timely and accurate delivery of supplies/equipment.Maintains patient privacy

We view our culture as a competitive advantage and a foundation for continued success.

We are a very busy office and are looking for our next great team member.This busy insurance and financial services office has a passion to make a difference in the lives of others and better the community.Our team is comprised of results-oriented individuals that are serious about their development

Customer Service Representative.This job is located at 738 A East 233rd St.PLS Overview: Why PLS? Because You Deserve Better! PLS which stands for People Location Service is a leading retail provider of financial services.The "P" comes first, because our customers are at the center of everything

Customer Service Representative.Location: Remote to Port Washington, NY.Compensation: English Speaking - $17.Weekly Pay + Optional Benefits.Schedule: Work hours: M-F 11:00am 7:15pm & Training is (9am 5pm) for 2 weeks (35 hours a week).Contract Length: 3 months| Extension + Conversion Opportunities

Licensed Customer Service Representative.We are seeking a licensed customer service representative to join our dedicated team.The ideal candidate will be responsible for delivering exceptional customer support, managing policy service requests, assisting clients with their insurance needs.This posit

Do You Want A Career And Not Just A Job?.As a customer service representative - state farm agent team member with Mike O'Boyle - state farm agent, you will generate the kind of exceptional customer experiences that reinforce the growth of a successful insurance agency.Your attention to detail, custo

This busy insurance and financial services office has a passion to make a difference in the lives of others and better the community.We are an established, growth-oriented agency with a team of highly motivated individuals.We attribute our success to having a fun, energetic environment that is an en