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Clinical Guidelines Remote Jobs

24 fresh jobs found
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Medical Director, Operations, Ortho/Spine
United States

Cohere Health Remote-first

Physician training Spine surgery Medical coverage policies Clinical decision guidelines Orthopedic surgery Remote workforce management AI in Healthcare Peer-to-peer discussions Clinical reviews +26

Exec Senior Full Time

USD 270K+

Medical Director - Home Health - OneHome/Home Solutions
Remote US, United States

CMS Medicare Collaborative relationships LCD NCD Inpatient care Clinical patient care Team culture CMS policies Clinical reference materials +50

Exec Senior Full Time

USD 223K+

Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
Tennessee Work at Home, United States

The Cigna Group

Case conferences Medical licenses Board certifications Peer-to-peer discussions Cigna Ncqa standards Federal Laws Medical Review Clinical Review +21

Exec Senior Full Time

USD 203K+

Case Management Coordinator
Remote, United States

Personify Health

Wellbeing Medical claims Hcpcs coding Data evaluation Clinical Guidelines Patient Assessment HCPCS ICD-10 Treatment Planning +15

USD 44K+

National Sr. Director, Product Development, Health & Science
Dallas, TX, United States

American Heart Association

Medical literature Volunteer Engagement Systematic Reviews Health Equity Volunteer Management Clinical Guidelines Emergency Medicine Succession Planning Program development +10

Senior Mid Full Time

USD 150K+

Medical Director - Southeast Region
Remote US, United States

Health claims Clinical patient care Health claims review Computer-Based Review Post-acute services Outpatient services Grievance and appeals processes CMS policies Post-acute care +90

Exec Senior Full Time

USD 223K+

Utilization Review Nurse
Remote

Level of Care Reviews Medical necessity reviews RN licensure Evidence-Based Guidelines Treatment Clinical Guidelines Clinical Judgment Clinical Review Clinical Practice +14

USD 70K+

DME Intake Management Specialist
US Brightree (Remote Workforce), United States

DME qualification HIPAA standards Clinical Guidelines Document management HIPAA Compliance Accounts Receivable Configuration HIPAA Microsoft Word +13

USD 48K+

Medical Director--Claims Management
Remote US, United States

Inpatient care Clinical patient care Computer-Based Review Outpatient services Home health services Grievance and appeals processes Clinical reference materials CMS policies Post-acute care +87

Exec Senior Full Time

USD 223K+

Senior LTSS Service Care Manager (RN)
Austin-13620 FM 620 Building C Suite 300 (11121), United States

Centene Corporation

Medicaid health assessments Personalized care plan Member advocacy Service authorization Continuum of care Service plan Quality care Long Term Care Health Assessments +38

Senior Full Time

USD 127K+

Senior LTSS Service Care Manager (RN)
Corpus Christi - 711 N. Carancahua St., Ste 600 (Superior) (10086), United States

Centene Corporation

Rehab Personalized care plan Member advocacy ICU Service authorization Service plan Continuum of care Long Term Care Service coordination +44

Senior Full Time

USD 70K+

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

Centene Corporation

Long-term care planning Medicaid health assessments Community Resource Coordination Personalized care plan Member advocacy Service authorization Service plan Continuum of care Quality care +39

Senior Full Time

USD 127K+

Primary Care Embedded Clinical Pharmacist
Remote Work - New York, United States

University of Rochester

Pharmacotherapy Drug Therapy Optimization Clinical pharmacy Pharmacokinetics Interdisciplinary Teamwork Clinical Guidelines Medication management Patient Education Quality Assurance +5

USD 131K+

Auditor Clinical Validation DRG
Remote, United States

Medical claims billing Payer reimbursement policies Coding terminology Medical audit Clinical chart validation Chart validation Payer reimbursement Coding Principles Billing guidelines +45

USD 45K+

LTSS Assessor RN
Remote-NY, United States

Centene Corporation

Clinical guidelines compliance Service plan Personalized care plan Community resources coordination Member advocacy UAS Healthcare provider collaboration Service authorization Continuum of care +34

USD 70K+

Medical Director - Medicaid N. Central
Remote US, United States

Health claims review Computer-Based Review Post-acute services Grievance and appeals processes Post-acute care Humana policies Family practice Clinical group practice management Medical interpretation +92

Exec Senior Full Time

USD 223K+

Utilization Review Nurse
Remote

Clinical auditing Clinical Guidelines Medical necessity Utilization Review Medical Billing Prior authorization Microsoft Suite Quality improvement Healthcare services +12

USD 80K+

Medical Director - Care Plus
Remote US, United States

Grievance processes Health claims review Outpatient services Grievance and appeals processes Post-acute care Clinical group practice management Commercial health insurance Hospitalist Inpatient rehabilitation +90

Exec Senior Full Time

USD 223K+

Medical Director, Operations, Ortho/Spine
United States

Cohere Health Remote-first

Clinical decision guidelines Medical coverage policies Physician training Remote workforce management AI in Healthcare Peer-to-peer discussions Clinical reviews Clinical Intelligence Software tools +23

Exec Senior Full Time

USD 270K+

Digital First - Mental Health Practitioner
London, England, United Kingdom - Remote

Self-care advice Holistic assessment Multidisciplinary teamwork Health promotion Clinical Guidelines Evidence-based treatment Clinical Supervision Crisis Management Regulatory standards +5

Senior Mid Full Time

GBP 49K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Outpatient services Grievance and appeals processes Post-acute care Humana policies Hospitalist Medical interpretation National Guidelines Family practice +83

Exec Mid Full Time

USD 223K+

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

Centene Corporation

Medicaid Assessments Quality care Rehab ICU Continuum of care Service authorization Service coordination Long Term Care Healthcare Education +39

Senior Full Time

USD 70K+

Behavioral Health Medical Director - Medicaid
Remote US, United States

Computer-Based Review CGX Community Groups Clinical reference materials CMS policies Medical background MCG Medical Director Clinical evaluation +48

Exec Senior Full Time

USD 223K+

Maternity Clinical Practice Advisor
Remote-NV, United States

Centene Corporation

Maternal care Utilization metrics Clinical Practice Guidelines RN licensure Community partnerships Clinical Initiatives Quality performance Billing practices Clinical Standards +43

USD 68K+

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