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Clinical Guidelines Remote Jobs

18 fresh jobs found

Medical Director, Clinical Policy
United States

Cohere Health Remote-first

Clinical writing Clinical Policy Clinical programs Clinical Strategy Scientific research Clinical Guidelines Clinical Intelligence Clinical Review Healthcare policy +17

Exec Senior Full Time

USD 250K+

Medical Director - OneHome/Home Heatlth
Remote US, United States

LCD NCD Interpretative Clinical reference materials CMS policies Family practice Medical interpretation Clinical Standards National Guidelines +44

Exec Senior Full Time

USD 223K+

Utilization Review Nurse
Remote

Care engagement Level of care reviews Milliman care guidelines Medical necessity reviews Evidence-Based Guidelines Clinical Guidelines Clinical Review RN licensure Technology Platform +13

USD 70K+

Medical Director - Florida
Remote US

Home health services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Inpatient rehabilitation Post-acute care Clinical group practice management Hospitalist +81

Exec Senior Full Time

USD 223K+

Senior LTSS Service Care Manager (RN)
Remote-TX, United States

Centene Corporation

Member advocacy Service Assessment Service plans Foster care Healthcare benefits Medical Services Long Term Care Healthcare Coordination Clinical Guidelines +11

Senior Full Time

USD 125K+

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+

LTSS Service Care Manager - Behavioral Health
Remote-TX, United States

Centene Corporation

Service Assessment Treatment options Service plans Service coordination Healthcare benefits Foster care Home visits Substance Use Disorder Clinical Guidelines +18

USD 93K+

Auditor Technical Trainer (Outpatient/Specialty Audits)
Remote, United States

Healthcare Auditing Audit Productivity Coding Principles Instructional Methods Concept Development Claims auditing Payment Decision Trees Clinical Guidelines +42

Senior Mid Full Time

USD 99K+

Reviewing Medical Director
Remote US

Grievance processes Care facilitation Post-acute services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Post-acute care Inpatient rehabilitation +93

Exec Senior Full Time

USD 199K+

Health Coach Consultant RN Chronic Conditions
Work At Home-North Carolina

Chronic Conditions Healthcare Guidelines Assessment Techniques Group Coaching Telephonic coaching Clinical Tools Holistic approach WebEx Data Review +34

USD 54K+

Director, Behavioral Health Strategy - National
Remote-MO, United States

Centene Corporation

Mental health parity Community services Accreditation Standards Accreditation Healthcare Policies Clinical Guidelines Healthcare policy Psychology Program development +19

Exec Senior Full Time

USD 113K+

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+

Medical Director - Southeast Region
Remote US

Health claims review Post-acute services Grievance and appeals processes Outpatient services Social determinants Inpatient rehabilitation Commercial health insurance Post-acute care Coding practices +80

Exec Senior Full Time

USD 199K+

Medical Director - Gulf South
Remote US

Health claims review Commercial health insurance Outpatient services Grievance and appeals processes Social determinants Hospitalist Clinical group practice management Clinical reference materials Inpatient rehabilitation +81

Exec Senior Full Time

USD 199K+

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+

Medical Policy Writer (Temp to Perm)
Remote, United States

Cohere Health Remote-first

Scientific research Clinical Guidelines Medical Writing Clinical Intelligence Documentation Management Utilization Review Training and Development Policy Development Clinical expertise +14

USD 110K+

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+

Health Coach - Registered Dietitian
Work At Home-Texas

Lifestyle Behavior Change Diet Planning Weight management Medical Nutrition Therapy Clinical Tools Holistic approach Data Review Clinical Guidelines Health coaching +24

Senior Mid Full Time

USD 46K+

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