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Remote Utilization Management Jobs

36 fresh jobs found

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+

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+

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

Centene Corporation

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

USD 182K+

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+

Utilization Management Nurse Consultant
Work At Home-Virginia, United States

RN license Clinical Tools Benefit utilization Benefit management Data Review Telephonic Communication Discharge planning Medical necessity Utilization Review +18

USD 58K+

Utilization Management Nurse Consultant (Weekend)
Work At Home-Illinois, United States

Med Compass CM/UM certification IT platforms Med/surg Benefit utilization Coverage determination Benefit management RN licensure Clinical Criteria +23

Entry Mid Full Time

USD 64K+

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+

Physician Reviewer, Utilization Management (part-time)
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 Part Time

USD 202K+

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+

Utilization Management Nurse Consultant
Work At Home-Michigan, United States

CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20

Entry Mid Full Time

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Kansas, United States

CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20

Entry Mid Full Time

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Illinois, United States

Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication Medical necessity +25

USD 64K+

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+

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

Patient care planning Clinical determinations Clinical evaluation Healthcare Policies Medical Services Medical necessity Prior authorization Care Coordination Utilization management +9

USD 106K+

Utilization Management Clinical Consultant - Remote Kentucky
Work At Home-Kentucky, United States

Healthcare services coordination Triage support Crisis support Clinical Practice Guidelines Navigating multiple systems Keyboarding Benefit management Benefit utilization Evidence-Based Care +24

USD 52K+

Behavioral Health Utilization Management Clinician I - MHP or SUDP
Seattle, Washington, United States

Community Health Plan of Washington

Workflow systems Clinical Guidelines Patient advocacy Utilization Review Discharge planning Care Coordination Utilization management Care management Clinical Experience +9

USD 73K+

Utilization Management Nurse Consultant
Work At Home-New York, United States

Healthcare services coordination Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication +25

USD 64K+

Utilization Management Nurse Consultant
Work At Home-Florida, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +21

USD 52K+

Utilization Management Nurse Consultant
Work At Home-North Carolina, United States

Multi-systems navigation Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Electronic Medical Records +24

USD 52K+

Utilization Management Clinician Behavioral Health
Work At Home-Pennsylvania, United States

Navigating systems Clinical Practice Guidelines Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Mental health services Evidence-Based Care +23

USD 60K+

Utilization Management Clinician Behavioral Health 4 day
Work At Home - Utah, United States

Substance abuse disorders Clinical Practice Guidelines Benefit management Substance abuse Mental health services Evidence-Based Care Call Center Experience Psychology Clinical Practice +14

USD 54K+

RN Utilization Management Review - SNF
Remote US, United States

Interpreting Criteria Health Plan Experience Clinical Nursing Medical Services Rehabilitation Acute care Consumer Experiences Registered Nurse Clinical knowledge +36

USD 71K+

Utilization Management Clinician Behavioral Health Overnight Shift 4 days
Work At Home-Missouri, United States

Substance abuse disorders Clinical Practice Guidelines Benefit management Substance abuse Mental health services Evidence-Based Care Call Center Experience Psychology Clinical Practice +14

USD 54K+

Utilization Management Nurse Consultant
Work At Home-Nevada, United States

Clinical call center Clinical Judgement Concurrent review Long Term Care Benefit management Benefit utilization Clinical Criteria Home Health Disease Management +19

USD 58K+

Transition of Care Registered Nurse, Utilization Management (mostly remote)
220 East 42nd Street, United States

Evidenced Based Criteria Clinical Determination Healthcare Policies Medical necessity Prior authorization Care Coordination Registered Nurse Utilization management Case Management +3

USD 106K+

Analyst , Medical Cost Analytics / Utilization Management - Remote
Work At Home-Massachusetts, United States

Strategic consulting Healthcare Data Predictive Modeling Utilization management Big Data Statistical analysis Business strategy Microsoft PowerPoint Health care +23

Entry Mid Full Time

USD 83K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania, United States

Keyboarding Coverage determination Healthcare Coordination Benefit utilization Benefit management Computer Systems Clinical Criteria Telephonic Communication RN licensure +25

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Ohio, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +30

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Texas, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Arizona, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 52K+

RN - Utilization Management
Work at Home - Florida, United States

Interpreting Criteria Health Plan Experience Clinical Nursing Medical Services Rehabilitation Acute care Consumer Experiences Registered Nurse Utilization management +42

USD 71K+

Utilization Management Clinical Supervisor
Work From Home - AZ, United States

Virtual collaboration Clinical Review Microsoft Applications HCPCS CPT Leadership Development Microsoft Teams Performance monitoring Utilization management +25

USD 55K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Evidence-Based Guidelines Peer-to-peer discussions Clinical Decision Making Software tools Clinical Review Medical necessity Clinical Intelligence +12

Senior Mid Full Time

USD 200K+

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