ZipRecruiter

Log In

2

Assistant Remote Utilization Review Jobs in California

previous page

Showing results 41-60

All JobsUtilization Review JobsAssistant Remote Utilization Review JobsAssistant Remote Utilization Review Jobs in California

Assistant Remote Utilization Review information

What is the difference between Assistant Remote Utilization Review vs Utilization Review Nurse?

AspectAssistant Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certification in case management or utilization reviewRegistered Nurse (RN) license, often with additional certifications in case management or utilization review
Work EnvironmentRemote, administrative setting, telehealth or telecommutingRemote or hospital/clinic settings, primarily telehealth or administrative
Employer & IndustryHealth insurance companies, managed care organizations, healthcare providersHospitals, insurance companies, healthcare organizations

Both roles involve reviewing patient cases to determine appropriate care and resource utilization. The Assistant Remote Utilization Review typically supports the process with administrative tasks and basic review, while the Utilization Review Nurse performs more in-depth clinical assessments. Both require nursing credentials and often work remotely within healthcare or insurance industries.

What are the most commonly searched types of Remote Utilization Review jobs in California? The most popular types of Remote Utilization Review jobs in California are:
What are popular job titles related to Assistant Remote Utilization Review jobs in California? For Assistant Remote Utilization Review jobs in California, the most frequently searched job titles are:
What job categories do people searching Assistant Remote Utilization Review jobs in California look for? The top searched job categories for Assistant Remote Utilization Review jobs in California are:
Assistant Remote Utilization Review jobs near you

Medical Director Utilization Management Oncology

The Oncology Institute of Hope and Innovation

Cerritos, CA • Remote

Full-time

Re-posted 23 days ago

Job description

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California         Nevada               Arizona               Oregon                Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.  

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes. 

 Key Responsibilities: 

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices. 
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices. 
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.  
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage. 
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement 
  • Partner with clinical and operational teams to support value-based care. 
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions. 
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology. 

Qualifications: 

  • Medical degree (MD or DO) 
  • Board Certification in Oncology. 
  • Minimum of 5 years of clinical experience in oncology. 
  • 2+ years of Utilization Management experience 
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans. 
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies. 
  • Excellent analytical skills and the ability to evaluate complex clinical data. 
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting. 
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients. 

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

Apply