Regional Medical Director- (Philadelphia/Baltimore)
CareAllies —Philadelphia, PA
- $191,500 - $355,600 a year
- Full-time
- Remote
- Medicine
- 3 years
- Analysis skills
- Paid parental leave
- Paid holidays
Utilization Management Nurse Consultant
CVS Health —Pennsylvania
- $29.10 - $62.32 an hour
- Full-time
- Remote
- Google Workspace
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
1d
Utilization Review Business Support Specialist
Allegheny Health Network —Pennsylvania
- $21.97 - $34.39 an hour
- Full-time
- Remote
- HIPAA
- Mid-level
- 3 years
2d
Implementation Consultant Utilization Management
Capital Blue Cross —Harrisburg, PA
- $72,870 - $137,290 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- Writing skills
- Paid holidays
- Health insurance
2d
Care Manager RN - UM (Full-Time) Weekends (Remote)
Highmark Inc. —Pennsylvania
- $68,400 - $105,900 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
8d
Medical Case Manager - Pediatric Shift Care (RN) Remote
Highmark Inc. —Pennsylvania
- $72,700 - $116,600 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
3d
Medical Claim Analyst
CVS Health —Pennsylvania
- $18.50 - $38.82 an hour
- Full-time
- Remote
- Customer service
- Research
- Mid-level
- Health insurance
- Dental insurance
2d
Utilization Review Coordinator
Pyramid Healthcare —Allentown, PA
- $20 an hour
- Full-time
- Remote
- Microsoft Excel
- Addiction Medicine
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Clinical Appeals Nurse - Full Time Remote - Jefferson Health
Thomas Jefferson University and Hospitals —Philadelphia, PA
- Full-time
- Remote
- Microsoft Word
- Nursing
- RN License
- AD&D insurance
- Disability insurance
Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO
Federal Hearings And Appeals —Wilkes-Barre, PA
- Contract
- Remote
- Medicine
- Surgery
- Addiction Medicine
Quick Apply
Clinical Assessor (Remote) - 1st Shift
Pyramid Healthcare —Altoona, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply
Clinical Assessor (Remote) - Mid Day Shift
Pyramid Healthcare —Altoona, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Coordinator (FWA)
AcariaHealth Pharmacy —Pennsylvania
- $19.43 - $32.98 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
- Paid holidays
- Health insurance
1d
Clinical Assessor (Remote) - Wednesday Through Saturday (10 hour shifts)
Pyramid Healthcare —Allentown, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d
Clinical Assessor (Remote) - Wednesday Through Sunday
Pyramid Healthcare —Allentown, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d
Physician Advisor - Penn Medicine
Penn Medicine —Philadelphia, PA
- Online Application
- Remote
- Medicine
- 5 years
- BC/BE
- Tuition reimbursement
Quick Apply
Physician Advisor II - Remote
Med-Metrix —Philadelphia, PA
- 8 hour shift
- Remote
- Medicine
- BC/BE
- HIPAA
Clinical Assessor (Remote) - Thursday Through Sunday (10 hour shifts)
Pyramid Healthcare —Allentown, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply
11d
Medical Director (MD) - remote (PA/NJ/DE)
Independence Blue Cross —Philadelphia, PA
- Monday to Friday
- Remote
- Medicine
- Pediatrics
- Senior level
Clinical Assessor (Remote) - 2nd Shift
Pyramid Healthcare —Altoona, PA
- Full-time
- Remote
- LMFT
- Addiction Medicine
- RN License
- Health insurance
- Dental insurance
Quick Apply

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utilization review remote jobs near pennsylvania

Regional Medical Director- (Philadelphia/Baltimore)

CareAllies -
Philadelphia, PA

Apply Now

Job Details

Full-time
$191,500 - $355,600 a year

Benefits

Paid parental leave
Paid holidays
Disability insurance
401(k)
Tuition reimbursement
Paid time off
Pension plan
Parental leave
Employee assistance program
Life insurance

Qualifications

Managerial strategic planning
Medical License

Full Job Description

At CareAllies , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Job Summary

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives. Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.

Required Job Qualifications:

Physician with a current and unrestricted physician license in a state or territory of the United States.
Maintain Board Certification as a M.D. or D.O. (by a specialty board approved by the American Board of Medical Specialties (doctors of medicine); or the Advisory Board of Osteopathic Specialists (doctors of osteopathic medicine)
5 years of clinical experience
Analytical and communication skills
Strategic thinking skills

Preferred Job Qualifications:

Ability to travel
3 years Managed Care experience
IPA (independent Physician Association) MSO or Value Based Enablement Organization Experience
Advanced skills in clinical interpretation, communication, data-driven strategy, and collaborative leadership
Experience with Stars performance, risk adjustment education, or provider engagement
Experience in matrixed environments and cross-functional clinical leadership.

Remote work located in Philadelphia and Baltimore.

INAK

#LI-MG1

#LI-Remote

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement:

At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees .

The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range:

$191,500.00 - $355,600.00

Exact compensation may vary based on skills, experience, and location.

Apply Now

Refine Your Search

utilization review remote jobs in pennsylvania

Regional Medical Director- (Philadelphia/Baltimore)

Utilization Management Nurse Consultant

Utilization Review Business Support Specialist

Implementation Consultant Utilization Management

Care Manager RN - UM (Full-Time) Weekends (Remote)

Medical Case Manager - Pediatric Shift Care (RN) Remote

Medical Claim Analyst

Utilization Review Coordinator

Clinical Appeals Nurse - Full Time Remote - Jefferson Health

Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO

Clinical Assessor (Remote) - 1st Shift

Clinical Assessor (Remote) - Mid Day Shift

Pharmacy Coordinator (FWA)

Clinical Assessor (Remote) - Wednesday Through Saturday (10 hour shifts)

Clinical Assessor (Remote) - Wednesday Through Sunday

Physician Advisor - Penn Medicine

Physician Advisor II - Remote

Clinical Assessor (Remote) - Thursday Through Sunday (10 hour shifts)

Medical Director (MD) - remote (PA/NJ/DE)

Clinical Assessor (Remote) - 2nd Shift

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