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Clinical Guidelines Remote Jobs

24 fresh jobs found

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+

Medical Director - Southeast Region
Remote US, United States

Computer-Based Review Health claims review Post-acute services Grievance and appeals processes Outpatient services Inpatient rehabilitation Post-acute care Clinical group practice management Commercial health insurance +87

Exec Senior Full Time

USD 223K+

Auditor Clinical Validation DRG
Remote, United States

Medical audit Coding Principles Clinical chart validation Payer reimbursement Billing guidelines Provider Billing Audit tools Chart validation Clinical coding +42

USD 44K+

Pediatric RN, Team Lead Case Manager
Remote-TX, United States

Centene Corporation

Resource utilization group certification Long-term care planning Pediatric case management Health risk assessment Service coordination Pediatrics Clinical Guidelines Utilization Personalized care plans +31

Senior Mid Full Time

USD 152K+

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

Centene Corporation

Continuum of care Service plan development Member advocacy Service authorization Service coordination Utilization Healthcare Coordination Clinical Guidelines Quality of care +33

Senior Full Time

USD 127K+

Case Management Coordinator
Remote, United States

Personify Health

Data evaluation Hcpcs coding Medical claims Clinical Guidelines Patient Assessment Treatment Planning HCPCS ICD-10 Care Coordination +13

USD 44K+

UM Clinical Specialist RN - Physical Health (Full-time Remote, North Carolina Based)
Remote, North Carolina, United States; Morrisville, North Carolina, United States; Charlotte, North Carolina, United States; Fayetteville, North Carolina, United States

Alliance Health

Medical necessity assessment Referral Clinical Guidelines Utilization Review Technical Assistance Utilization management Quality improvement Managed Care Nursing +10

USD 66K+

Grievance & Appeals Analyst (Full time Remote, North Carolina Based)
Morrisville, North Carolina, United States; Remote, North Carolina, United States; Charlotte, North Carolina, United States; Fayetteville, North Carolina, United States

Alliance Health

Grievance Management Clinical Guidelines Mediation Provider Relations Organizing Report Writing Technical Assistance Public health MS Excel +19

Entry Mid Full Time

USD 56K+

Medical Director - Gulf South
Remote US, United States

Post-acute services Grievance and appeals processes Community Groups Outpatient services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +88

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Community Groups Outpatient services Grievance and appeals processes Inpatient rehabilitation Commercial health insurance Clinical group practice management Post-acute care Humana policies +83

Exec Senior Full Time

USD 223K+

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+

Senior Clinical Policy Analyst
Remote - NY, United States

Clinical Policy Medical Policies LMSW Medical research Clinical Guidelines Documentation Management MS Teams LCSW HIPAA Compliance +18

Senior Mid Full Time

USD 71K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

Medical Director- South Central
Remote US, United States

Community Groups Outpatient services Grievance and appeals processes Post-acute services Clinical group practice management Inpatient rehabilitation Post-acute care Commercial health insurance Humana policies +86

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+

Project Manager, Clinical Content
United States

Cohere Health Remote-first

Content curation Evidence-based medicine Clinical Intelligence Clinical Guidelines Google Drive Project Management Software Medical Writing Clinical expertise Content development +12

USD 85K+

Medical Director - Northeast Region
Remote US, United States

Community Groups Outpatient services Post-acute services Grievance and appeals processes Clinical group practice management Commercial health insurance Post-acute care Inpatient rehabilitation CMS policies +88

Exec Senior Full Time

USD 223K+

Staff Vice President UM Special Markets - FL
Remote-FL, United States

Centene Corporation

UM Healthcare Delivery Health Plan Clinical Guidelines Strategic Leadership Medical management Cross-functional Teams Procedures Data-driven decision making +28

Senior Full Time

USD 182K+

Medical Director - Southeast Region
Remote US, United States

Health claims review Community Groups Outpatient services Post-acute services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Humana policies +84

Exec Senior Full Time

USD 223K+

Medical Director - South Central
Remote US, United States

Community Groups Grievance and appeals processes Outpatient services Post-acute services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Social determinants +85

Exec Senior Full Time

USD 223K+

Field Medical Director, Interventional Cardiology (Remote)
Work at Home, United States

Utilization review accreditation Clinical rationale Cardiovascular utilization management Case reviews Medical Necessity Guidelines Peer-to-peer discussions Clinical Guidelines Interventional cardiology Clinical excellence +6

Exec Senior Part Time

USD 240K+

Medical Director - Mid West Region
Remote US, United States

Clinical guidelines knowledge Managed Care Knowledge Medicare Knowledge Commercial health insurance Clinical group practice management Inpatient rehabilitation Clinical Decision Making Social determinants Grievance and appeals +78

Exec Senior Full Time

USD 223K+

National Medicaid Medial Director - Long Term Services & Supports (LTSS)
Remote US, United States

Medical Authorization Community Groups Health Care Facilities Long Term Services & Supports Therapy Services Social determinants Post-acute care Clinical reference materials Medical background +73

Exec Senior Full Time

USD 223K+

Medical Director- South Central
Remote US, United States

Post-acute services Clinical group practice management Commercial health insurance Outpatient services Grievance and appeals processes Clinical Decision Making Post-acute care Inpatient rehabilitation Social determinants +83

Exec Senior Full Time

USD 223K+

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