Top 1923 Healthcare compliance privacy Jobs in Remote

Utilization Management Physician Reviewer (PA or NJ)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
Quick Apply
CDI Specialist
OnPoint Healthcare Solutions —Remote
- $50 - $65 an hour
- Full-time
- Remote
- Anatomy knowledge
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Director - System Privacy Officer
UnityPoint Health —West Des Moines, IA
- Full-time
- Remote
- HIPAA
- Master's degree
- 8 years
- Paid holidays
- Disability insurance
14d
Data Entry Specialist - Medical Records (Remote)
Sharecare —Remote
- Full-time
- Remote
- Customer service
- HIPAA
- Ability to sit for extended periods
5d
Privacy & Compliance Coordinator
Med Communications —Remote
- Full-time
- Remote
- HIPAA
- Mid-level
- Bachelor's degree
Quick Apply
14d
Medical Credentialing Coordinator
Curana Health —Remote
- Full-time
- Mid-level
- Databases
- High school diploma or GED
Claims - Claims Examiner
Wellcove —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
ROI Medical Records Specialist - Remote
Sharecare —Remote
- Full-time
- Remote
- Microsoft Word
- Microsoft Excel
- HIPAA
Healthcare TPA Member Services Processing Analyst
General Dynamics Information Technology —Remote
- $55,250 - $74,750 a year
- HIPAA
- Mid-level
- Administrative experience
- Paid holidays
- 401(k) matching
Quality Management Specialist (Healthcare) - Fully Remote
MRIoA —Remote
- Full-time
- Remote
- Microsoft Word
- Background check
- 5 years
- Paid holidays
- Health insurance
Quick Apply
Specialist, Risk Adjustment
Oscar Health —Remote
- $29.86 - $39.19 an hour
- Overtime
- Remote
- Research
- Mid-level
- Bachelor's degree
- Paid parental leave
- Paid holidays
Quick Apply
6d
Privacy Analyst
Public Partnerships LLC —Remote
- $77,500 - $102,600 a year
- Full-time
- Remote
- Nursing
- HIPAA
- Mid-level
Quick Apply
4d
Clinical Documentation Specialist (CDI)
Solventum —Remote
- $96,000 - $132,000 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Health savings account
- Disability insurance
14d
(REMOTE) Healthcare Customer Service Agent
Widescope Consulting and Contracting Services LLC —Remote
- $17.75 - $23.33 an hour
- Overtime
- Remote
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Paid holidays
- 401(k) matching
Quick Apply
9h
Medical Records Specialist
TopDog Law LLC —Remote
- Full-time
- Remote
- Microsoft Outlook
- HIPAA
- Mid-level
- Health savings account
- Disability insurance
Quick Apply
5d
Associate, Regulatory Operations
Oscar Health —Remote
- $101,844 - $133,670 a year
- Overtime
- Remote
- Mid-level
- Office
- Bachelor's degree
- Paid parental leave
- Paid holidays
Quick Apply
Healthcare Integration Specialist
Cibolo Health —Remote
- $105,000 - $110,000 a year
- Full-time
- Remote
- Background check
- Computer Science
- Pass drug screening
Quick Apply
1d
Licensing Specialist (Contract)
Midi Health —Remote
- $35 an hour
- Contract
- Remote
- Mid-level
- Bachelor's degree
- US work authorization
- Flexible schedule
Compliance Lead
Fullscript —Remote
- $125,000 - $150,000 a year
- Email
- Remote
- 7 years
- HIPAA
- Senior level
Quick Apply
Director, Patient Support Programs (PSP)
LivaNova —Remote
- $170,000 - $190,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Bachelor of Science
- Employee stock purchase plan
- Health insurance

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healthcare compliance privacy jobs near remote

Utilization Management Physician Reviewer (PA or NJ)

Toney HealthCare Consulting, LLC -
Remote

Quick Apply

Job Details

Part-time | Contract
$175 - $200 an hour

Benefits

Health insurance

Qualifications

Electronic health records (EHR) management
Utilization management
Resource utilization in healthcare
Medical License

Full Job Description

Job Overview

The Physician Reviewer serves as a clinical subject matter expert in the Utilization Management (UM) department. This role is responsible for conducting clinical reviews of medical necessity, appropriateness of care, and service requests based on evidence-based guidelines, medical policy, and regulatory requirements. The Physician Reviewer collaborates with UM nurses, medical directors, and other healthcare professionals to ensure appropriate, timely, and cost-effective care for members.

Key Responsibilities:

Conduct physician-level reviews of prior authorization, concurrent review, and retrospective review cases across multiple lines of business (e.g., commercial, Medicaid, Medicare).
Apply nationally recognized clinical criteria (e.g., MCG, InterQual), internal medical policies, and applicable regulations (CMS, NCQA, URAC) to review determinations.
Render clinical decisions in a timely manner consistent with regulatory timeframes and health plan policies.
Collaborate with medical directors, case managers, and care teams to support optimal care pathways.
Participate in audits, appeals, and grievance processes as needed.
Maintain current knowledge of clinical best practices, industry trends, and regulatory changes.
Participate in peer-to-peer discussions with attending physicians to communicate UM decisions and promote evidence-based care.
Analyze clinical data and documentation to support accurate determinations and appeals.
Contribute to the development and refinement of clinical policies and UM protocols specific to specialized care.
Provide guidance on clinical appropriateness, benefit coverage, and policy interpretation.
Provide education and clinical support to internal teams and external providers regarding best practices and clinical pathways.
Ensure compliance with regulatory, accreditation, and legal requirements in all UM activities.
Ensure adherence to all HIPAA, confidentiality, and privacy standards.
Participate in quality improvement initiatives and clinical case rounds.

Qualifications:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree required.
Active and unrestricted medical license in PA or NJ.
Minimum of 5 years of clinical practice experience in the respective specialty.
At least 3 years of experience in utilization management within a health plan.
Familiarity with evidence-based guidelines and UM tools (e.g., InterQual, MCG).
Strong communication and documentation skills.
Proficiency with electronic medical records and clinical review platforms.
Experience with Medicare/Medicaid and commercial insurance regulations is preferred.

Preferred Skills:

Experience with Medicare and/or Medicaid managed care plans.
Knowledge of medical necessity appeal processes and peer review protocols.
Knowledge of CMS, NCQA, and/or URAC standards.
Previous peer review or medical director experience.
Comfortable working in a remote, collaborative environment.

Pay: $175.00 - $200.00 per hour

Application Question(s):

Availability to work weekends (part-time or full-time) between 8:00 AM and 5:00 PM ET on Saturdays and/or Sundays is required.

Experience:

Utilization Management Review: 3 years (Required)
Medicare and/or Medicaid: 2 years (Required)

License/Certification:

Board-certified M.D. or D.O. medical license? (Required)
PA or NJ Medical License? (Required)

Work Location: Remote

Quick Apply

Refine Your Search

healthcare compliance privacy jobs in remote

Utilization Management Physician Reviewer (PA or NJ)

CDI Specialist

Director - System Privacy Officer

Data Entry Specialist - Medical Records (Remote)

Privacy & Compliance Coordinator

Medical Credentialing Coordinator

Claims - Claims Examiner

ROI Medical Records Specialist - Remote

Healthcare TPA Member Services Processing Analyst

Quality Management Specialist (Healthcare) - Fully Remote

Specialist, Risk Adjustment

Privacy Analyst

Clinical Documentation Specialist (CDI)

(REMOTE) Healthcare Customer Service Agent

Medical Records Specialist

Associate, Regulatory Operations

Healthcare Integration Specialist

Licensing Specialist (Contract)

Compliance Lead

Director, Patient Support Programs (PSP)

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