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Remote Utilization Management Jobs

18 fresh jobs found

Clinical Evaluation Manager, Utilization Management (mostly remote)
220 East 42nd Street, United States

Patient care planning Healthcare Policies Clinical evaluation Medical Services Medical necessity Prior authorization Care Coordination Utilization management Care management +12

USD 106K+

Utilization Management Nurse 2-Remote, US
Work at Home - Kentucky, United States

Technical Savvy CGX Health Plan Experience Home Health Mobile Productivity Consumer Experiences Data interpretation Value-based care +50

USD 71K+

Utilization Management Review Nurse 2
Remote US, United States

Interpreting Criteria Health Plan Experience Clinical Nursing Medical Services Rehabilitation Acute care Consumer Experiences Health outcomes Registered Nurse +47

USD 71K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Peer-to-peer discussions Clinical Decision Making Evidence-Based Guidelines Software tools Gastroenterology Clinical Intelligence Patient outcomes +18

Senior Mid Full Time

USD 200K+

Supervisor, Utilization Management
Remote-OK, United States

Centene Corporation

UM Utilization Accreditation Standards Clinical Review Accreditation Prior authorization Medical management Health Services Utilization management +22

USD 73K+

Utilization Management Clinical Care Reviewer II - MUST be Multi-State Licensed
Mississippi WFH, United States

Clinical care review Proper grammar usage Medical Necessity Review Registered Nursing Phone Etiquette Provider engagement Discharge planning Accreditation Certification +33

USD 55K+

Case Manager RN (Remote), Day Shift, Utilization Management
Remote, United States

Adventist HealthCare

Independent work Crisis Management Utilization management Conflict Resolution Confidentiality Nursing Case Management Multi-tasking Documentation +3

USD 71K+

VP, PHCO Utilization Management Medicaid & Marketplace
Remote-MO, United States

Centene Corporation

Ncqa standards NCQA Clinical Training Financial Forecasting Provider Relations Acute care Marketplace Reconciliation Utilization Review +25

Exec Senior Full Time

USD 182K+

Utilization Management Market Operations Manager (Must live in Mississippi)
Mississippi WFH, United States

NCQA Provider engagement Problem identification Regulatory reporting Resolution CMS Performance Improvement Visio Quality improvement +32

Senior Mid Full Time

USD 73K+

VP, PHCO Utilization Management - Medicare & Duals
Remote-FL, United States

Centene Corporation

NCQA Ncqa standards Clinical Training Financial Forecasting Provider Relations Acute care Utilization Review Medical management Training Programs +21

Exec Senior Full Time

USD 182K+

Post-Acute Utilization Management Nurse (Gulf South Region)
Work at Home - Tennessee, United States

Interpreting Criteria Rehab Health Plan Experience CMS guidelines Clinical Nursing Medical Services Consumer Experiences Discharge planning CMS +41

USD 71K+

Utilization Management Nurse (Gulf South Region)
Work at Home - Louisiana, United States

Milliman Interpreting Criteria Health Plan Experience MCG Clinical Nursing Medical Services Acute care Consumer Experiences Discharge planning +46

USD 71K+

Utilization Management Nurse
Work at Home - Florida, United States

CGX Interpreting Criteria MCG Clinical Nursing Medical Services Registered Nurse Clinical knowledge Utilization management BI +38

USD 71K+

Physician Reviewer, Utilization Management
Remote

Workflow Tools Medical necessity criteria Evidence-Based Guidelines Peer-to-peer discussions Clinical Review Technology Platform Clinical Practice Clinical Acumen Utilization Review +13

Senior Full Time

USD 211K+

PNW PACE Utilization Management RN
Working Virtually, United States

MultiCare Health System

Chart documentation Authorization Insurance Industry Clinical Experience Utilization management Judgment Nursing Health care Patient care +10

Senior Full Time

USD 98K+

Utilization Management Review Nurse
Remote US, United States

Interpreting Criteria Health Plan Experience Clinical Nursing Rehabilitation Medical Services Health outcomes Acute care Consumer Experiences Registered Nurse +46

USD 71K+

Utilization Management Behavioral Health Professional
HGB SCA Remote KY, United States

Autism spectrum disorder Interpreting Criteria Tricare Applied Behavioral Analysis Medical Services CPT codes Prevention Productivity Process Management +48

USD 65K+

Supervisor, Utilization Management
Remote-NC, United States

Centene Corporation

Regulations knowledge UM Accreditation Standards Accreditation Clinical Review Procedures Health Services Prior authorization Medical management +17

USD 73K+

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