Indianapolis, IN · On-site
$247.84 - $446.11/hr
Appeals Medical Director - Medicare Location: This role enables associates to work virtually ... S. state or territory when conducting utilization review or appeals consideration; cannot be on a U.
Indianapolis, IN · On-site
$247.84 - $446.11/hr
Appeals Medical Director - Medicare Location: This role enables associates to work virtually ... S. state or territory when conducting utilization review or appeals consideration; cannot be on a U.
Appeals Medical Director - Medicare Appeals Medical Director - Medicare Location: This role enables ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Medicare Appeals Medical Director - Medicare Location: This role enables ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Granger, IN · On-site
... review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using ...
Indianapolis, IN · On-site
$247K - $446K/yr
Appeals Medical Director - Medicare Appeals Medical Director - Medicare Location: This role enables ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Indianapolis, IN · On-site
$247K - $446K/yr
Appeals Medical Director - Medicare Appeals Medical Director - Medicare Location: This role enables ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
$147K - $190K/yr
Participate in managed care and third-party payer programs designated by JPCHC, including Medicare ... Participate in quality assessment, utilization review, and quality improvement initiatives ...
$147K - $190K/yr
Participate in managed care and third-party payer programs designated by JPCHC, including Medicare ... Participate in quality assessment, utilization review, and quality improvement initiatives ...
... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS ...
New
... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS ...
New
... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS ...
New
... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS ...
New
Anderson, IN · On-site
$147K - $190K/yr
Participate in managed care and third-party payer programs designated by JPCHC, including Medicare ... Participate in quality assessment, utilization review, and quality improvement initiatives ...
Anderson, IN · On-site
$147K - $190K/yr
Participate in managed care and third-party payer programs designated by JPCHC, including Medicare ... Participate in quality assessment, utilization review, and quality improvement initiatives ...
Appeals Medical Director - Medicare Location: This role enables associates to work virtually ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Medicare Location: This role enables associates to work virtually ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Utilization review * Clinical pathways * Performance improvement initiatives * Ensure care delivery ... Support documentation, billing, and payer compliance (including Medicare and Medicaid). * Supervise ...
Utilization review * Clinical pathways * Performance improvement initiatives * Ensure care delivery ... Support documentation, billing, and payer compliance (including Medicare and Medicaid). * Supervise ...
Utilization review * Clinical pathways * Performance improvement initiatives * Ensure care delivery ... Support documentation, billing, and payer compliance (including Medicare and Medicaid). * Supervise ...
Utilization review * Clinical pathways * Performance improvement initiatives * Ensure care delivery ... Support documentation, billing, and payer compliance (including Medicare and Medicaid). * Supervise ...
Indianapolis, IN · On-site
$95 - $100/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $100/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $96/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $96/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $109/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
... utilization of resources, service delivery and compliance with external review agencies. Provides ... Knowledge of Medicare benefits and insurance processes and contracts. * Knowledge of accreditation ...
Indianapolis, IN · On-site
... utilization of resources, service delivery and compliance with external review agencies. Provides ... Knowledge of Medicare benefits and insurance processes and contracts. * Knowledge of accreditation ...
Indianapolis, IN · On-site
$95 - $96/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
Indianapolis, IN · On-site
$95 - $96/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector ...
$20.36 - $24.48
2% of jobs
$24.48 - $28.59
9% of jobs
$31.41 is the 25th percentile. Wages below this are outliers.
$28.59 - $32.71
21% of jobs
The median wage is $36.04 / hr.
$32.71 - $36.83
23% of jobs
$36.83 - $40.94
13% of jobs
$44.15 is the 75th percentile. Wages above this are outliers.
$40.94 - $45.06
10% of jobs
$45.06 - $49.18
8% of jobs
$49.18 - $53.30
5% of jobs
$53.30 - $57.41
5% of jobs
$57.41 - $61.53
2% of jobs
$61.53 - $65.65
2% of jobs
$20
$40
$65
In a Medicare Utilization Review role, your day-to-day tasks often include reviewing patient medical records to ensure services meet Medicare coverage criteria, evaluating the necessity and efficiency of proposed treatments, and communicating findings with healthcare providers. You’ll also submit detailed reports, coordinate with physicians, case managers, and insurance representatives, and follow up on documentation requests. Frequently, you’ll participate in interdisciplinary team meetings to discuss patient care plans and recommend alternative treatments if needed. This role requires balancing regulatory compliance with effective healthcare delivery, making each day dynamic and rewarding.
To thrive as a Medicare Utilization Review professional, you need a solid background in healthcare (often as an RN or LPN), strong analytical skills, and familiarity with Medicare regulations and guidelines. Experience using utilization management software, electronic health records (EHRs), and claim review systems like InterQual or MCG is typically required. Strong attention to detail, effective communication, and negotiation skills help set candidates apart. These competencies are crucial to ensure compliance, promote accurate claims processing, and support optimal patient care decisions within Medicare standards.
A Medicare Utilization Review job involves evaluating healthcare services to ensure they meet Medicare guidelines for medical necessity, cost-effectiveness, and quality of care. Professionals in this role review patient records, treatment plans, and insurance claims to determine appropriate coverage and prevent fraud or overutilization. They work closely with healthcare providers and insurance companies to ensure compliance with federal regulations. This role helps maintain the integrity of Medicare services while optimizing patient care and cost efficiency. Strong analytical skills and knowledge of medical coding, billing, and Medicare policies are essential for success in this position.
$247.84 - $446.11/hr
Other
Medical, Retirement
Posted 20 days ago
7.7
Based on 349 frontline employees who took The Breakroom Quiz
201st of 303 rated insurance
Anticipated End Date: 2026-08-14
Position Title: Appeals Medical Director – Medicare
Location: This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Candidates must be within a reasonable commuting distance unless accommodation is granted. Alternate locations may be considered.
ResponsibilitiesIn addition to salary (range $247,840 to $446,112 for specified locations), Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.
Equal Employment OpportunityElevance Health is an Equal Employment Opportunity employer and all qualified applicants receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable laws. Applicants requiring accommodation should submit the Accessibility Accommodation Request Form.
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Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Health care and social assistance
10,000+ Employees
Indianapolis, IN, US
2004
