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Clinical Criteria Remote Jobs

18 fresh jobs found

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

Inpatient utilization Med/surg Coverage determination Benefit utilization Benefit management Clinical Criteria RN licensure Medical necessity Discharge planning +22

USD 58K+

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+

LPN - Prior Authorization
Work At Home-Texas

Digital charting Medical Services Pharmacy benefits Pharmacist Navigating multiple systems Keyboarding Phone LVN Clinical Criteria +28

USD 44K+

Clinical Quality Nurse Reviewer, Sr. Specialist - (RN Remote in US)
Any city, ID, US, 99999

Gainwell Technologies

Inter-rater reliability Acute care experience Clinical quality review Production Environment MCG criteria Clinical criteria guidelines InterQual criteria Chart Audits Medical Record Review +36

Senior Full Time

USD 64K+

Utilization Management Nurse Consultant
Work At Home-Washington

Med/surg Coverage determination Long Term Care Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Telemetry +30

Senior Mid Full Time

USD 64K+

Nurse Reviewer, Appeals and Hearings (Remote)
Any city, LA, US, 99999

Gainwell Technologies

Appeals process MCG criteria Medical record coding Clinical criteria guidelines InterQual criteria Coding certification CCS CPC InterQual +28

USD 64K+

Utilization Management Nurse Consultant- Specialty Medications
Work At Home-Arizona

Clinical documentation systems Clinical Judgement Clinical call center Benefit utilization Phone Benefit management Clinical Criteria Clinical Documentation Prior authorization +17

Senior Mid Full Time

USD 52K+

Utilization Management Nurse Consultant - Remote
Work At Home-New York

Navigating multiple systems Benefit utilization Keyboarding Clinical Criteria RN licensure Clinical assessment Registered Nurse Computer Proficiency Utilization management +18

USD 52K+

Behavioral Analysis Utilization Management Clinical Consultant
Work At Home-Florida

Behavior Analysis Claims review Clinical Practice Guidelines Benefit utilization Benefit management Clinical Guidelines Clinical Criteria Electronic Medical Records Evidence-Based Care +26

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania

Benefit utilization Coverage determination Benefit management Telephonic Communication Medical necessity Clinical Criteria Acute care Discharge planning Utilization Review +20

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Ohio

Benefit utilization Coverage determination Benefit management Long Term Care Telephonic Communication Clinical Criteria Medical necessity Home Health Discharge planning +30

USD 52K+

Utilization Manager Nurse Consultant
Work At Home-Texas

Med/surg Inpatient utilization Benefit utilization Coverage determination Benefit management Medical necessity Clinical Criteria RN licensure Discharge planning +22

USD 58K+

Clinical Pharmacist - Medicaid Prior Authorization (NC or MA Licensed)
Work At Home-Massachusetts

Pharmacy experience Clinical pharmacy Phone Clinical Guidelines Clinical resources Clinical Criteria Specialty Pharmacy Insurance Verification Call Center Experience +23

USD 68K+

Utilization Management Nurse Consultant
Work At Home-North Carolina

Multi-systems navigation Benefit utilization Coverage determination Benefit management Navigating multiple systems Keyboarding Clinical Criteria Fast-paced Environment RN licensure +24

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Texas

Benefit utilization Coverage determination Benefit management Long Term Care Telephonic Communication Medical necessity Clinical Criteria RN licensure Home Health +32

USD 58K+

UM Nurse Consultant - Prior Authorization
Work At Home-Ohio

Benefit utilization Coverage determination Benefit management Navigating multiple systems Medical necessity Clinical Criteria Keyboarding RN licensure Discharge planning +27

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Nevada

Concurrent review Clinical Judgement Clinical call center Benefit utilization Benefit management Long Term Care Clinical Criteria Home Health Acute care +20

USD 58K+

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