Top Healthcare Services Jobs in Chicago, IL

Provide physician-led clinical review and coverage determinations for post-service claims, collaborating with providers and internal teams to ensure medically appropriate, cost-effective care. Document findings, engage in peer-to-peer discussions, interpret benefit language and policies, and contribute to quality improvement and provider education.

Provide physician oversight for medical claims and coverage determinations, conduct clinical reviews, document findings, engage in peer-to-peer discussions with providers, collaborate with multidisciplinary teams, and ensure cost-effective, evidence-based care for members.

Serve as a remote Medical Director performing prior authorization, utilization management, and claims/appeals reviews for Medicare Advantage members. Promote evidence-based medicine, provide clinical guidance to providers and patients, support quality initiatives, and make autonomous decisions in a production-driven environment.

Provide clinical leadership to improve evidence-based care, quality, utilization management, and member outcomes across national networks. Support reviews, appeals, clinical coverage, and data-driven initiatives in a remote, production-driven role.