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Clinical Judgment Remote Jobs

55 fresh jobs found

Case Manager RN (Remote)
Work At Home-Pennsylvania

Holistic Assessment Home health care coordination Proprietary applications Navigating multiple systems Data evaluation Keyboarding Clinical resources Clinical Tools Holistic approach +39

USD 60K+

Pharmacy Technician Call Center - Remote US
Any city, WI, US, 99999

Gainwell Technologies

Prior authorization processing Internet usage Pharmacy Knowledge Pharmacy benefit management Call center Operations Clinical Judgment Email Managed Care Medical +11

USD 33K+

Case Manager
High Point-4050 Piedmont Parkway

Telephonic case management Emergency department RN license Long Term Care Clinical resources Holistic approach Clinical Tools Data Review Policies and procedures +26

USD 54K+

Case Manager RN- Maternity
Work At Home-Arizona

Holistic Assessment Maternity Care Women's Health RN license Clinical resources Clinical Tools Holistic approach Policies and procedures Data Review +23

USD 54K+

Case Manager RN- Maternity/Fertility
Work At Home-Arizona

Maternity Telephonic case management Ob-gyn Infertility Women's Health RN license Clinical resources Clinical Tools Holistic approach +23

USD 54K+

Clinical Case Manager Behavioral Health DSNP
Work At Home-Pennsylvania

Provider coordination Substance abuse Technological Clinical Tools Data Review Care Planning Crisis Intervention Utilization Review Discharge planning +19

USD 60K+

Utilization Managment Nurse Consultant
Work At Home-California

Benefit management Benefit utilization Coverage determination Long Term Care Clinical Criteria Medical necessity Telephonic Communication RN licensure Utilization Review +29

Entry Mid Full Time

USD 64K+

Appeals Review Nurse
Remote

NCCN Medical decision support tools Level of care reviews Medical necessity reviews Milliman care guidelines Evidence-Based Guidelines InterQual MCG Clinical Guidelines +16

Entry Mid Full Time

USD 70K+

Wellness Coach - Registered Dietitian (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Weight management Physical activity Quality outcomes Sleep hygiene Wellness Coaching Tobacco cessation Exercise science Maternal health Evidence-based Interventions +27

Senior Mid Full Time

USD 50K+

Bilingual Family Nurse Practitioner (CA Licensed, Spanish Speaking)
Remote, United States

Family Nurse Practitioner Interdisciplinary Care Technology Feedback Social Needs Substance Use Disorder Clinical Judgment Care Coordination Virtual care Care management +11

USD 115K+

Case Manager RN (remote)
Work At Home - Utah

Clinical resources Holistic approach Clinical Tools RN licensure Policies and procedures Member engagement Data Review Care Planning Clinical Practice +20

USD 54K+

UM Nurse Consultant-Reconsideration
Work At Home-Arizona

Clinical call center Clinical Judgement Benefit utilization Benefit management Long Term Care Clinical Criteria Home Health Acute care Call Center Experience +19

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Arizona

Evidence-based clinical criteria Clinical documentation systems Clinical call center Clinical Practice Guidelines Clinical Judgement Phone Long Term Care Navigating multiple systems Clinical Criteria +22

USD 52K+

UM Nurse Consultant (Remote)
Work At Home-Ohio

Coverage determination Benefit utilization Benefit management Navigating multiple systems Clinical Criteria RN licensure Keyboarding Registered Nurse Clinical Judgment +17

USD 52K+

Clinical Case Manager Behavioral Health DSNP
Work At Home - Utah

Behavioral health consultation Provider coordination Clinical Case Management Community Resource Coordination Appeals Care Planning Clinical Practice Utilization Review Crisis Intervention +23

USD 54K+

Primary Nurse Case Admin I - CM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Medical Management Policies Condition Management Database experience Lotus Notes Coordination of care +29

USD 58K+

Utilization Management Clinical Consultant
Work At Home-West Virginia

Healthcare services coordination Clinical Practice Guidelines Benefit utilization Benefit management Navigating multiple systems Clinical Criteria Keyboarding Clinical Practice Utilization Review +26

USD 52K+

Utilization Review Nurse
Remote

Level of care reviews Medical necessity reviews Evidence-Based Guidelines Clinical Guidelines Acute care RN licensure Clinical Practice Clinical Review Utilization Review +11

USD 70K+

Primary Nurse Case Admin I - UM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Medical Management Policies Condition Management Database experience Coordination of care PC Proficiency +27

USD 58K+

Complex Case Manager - RN (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Disease Processes Condition Management Gastroenterology Care Planning Cultural Competency Analytic Clinical Judgment RN MS Excel +13

Senior Mid Full Time

USD 57K+

Virtual Primary Care Physician
Remote, United States

Synchronous video Digital-first healthcare Virtual medicine Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health Evidence-Based Care +17

USD 276K+

Virtual Primary Care Physician (NJ Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (MI Licensure)
Remote, United States

Patient management Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (MO Licensure)
Remote, United States

Synchronous video Digital-first healthcare Virtual medicine Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health Evidence-Based Care +16

USD 276K+

Virtual Primary Care Physician (IN Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (IL Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (HI Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (CT Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Primary Care Physician (CA Licensure)
Remote, United States

Patient Communication Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Technology Utilization Population health +16

USD 276K+

Virtual Urgent Care Clinician
Remote, United States

Digital-first healthcare Synchronous video Virtual medicine Acute care Family Medicine Resourcefulness Population health Urgent care Clinical Judgment +12

USD 156K+

Virtual Primary Care Physician (FL Licensure)
Remote, United States

Patient Communication Synchronous video Digital-first healthcare Virtual medicine Operational Rigor Family Medicine Resourcefulness Evidence-Based Care Technology Utilization +16

USD 276K+

Virtual Primary Care Physician (PA Licensure)
Remote, United States

Patient Communication Synchronous video Digital-first healthcare Virtual medicine Operational Rigor Family Medicine Resourcefulness Evidence-Based Care Technology Utilization +16

USD 276K+

Virtual Primary Care Physician (OH Licensure)
Remote, United States

Patient management Synchronous video Virtual medicine Digital-first healthcare Operational Rigor Family Medicine Resourcefulness Evidence-Based Care Technology Utilization +16

USD 276K+

Substance Use Disorder (SUD) Clinical Care Navigator
Remote

Contingency management ASAM levels of care Medication-assisted treatment Psycho-education Detox Substance use disorders Safety Planning Ethical Standards Evidence-based practices +31

USD 84K+

Primary Nurse CA Specialty - Oncology Certification Required (ERS)
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

CM UM Healthy coping Medical Management Policies Lotus Notes Database experience Coordination of care Goal setting PC Proficiency +25

USD 67K+

Primary Nurse Case Admin l UM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Condition Management Medical Management Policies Lotus Notes Database experience Coordination of care +29

USD 58K+

Holistic Health Specialist
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

MCG Certification Wellness education Milliman guidelines Condition Management Medical Management Policies Lotus Notes Database experience Coordination of care RN license +25

USD 58K+

Medical Director -Pediatric Surgery
Florida Work at Home

The Cigna Group

Evidence-based reviews Evidence-Based Decision Making Automated processes Case Management Software Computer Applications Federal Laws Medical necessity Healthcare Regulations Utilization Review +21

Exec Senior Full Time

USD 196K+

Utilization Management Clinical Processor - Dental
Work From Home - AZ

Dental benefit administration X-ray review Windows-based programs Medical Necessity Review Confidential information handling Medical necessity Clinical Judgment Utilization management Leadership Development +16

USD 36K+

Primary Nurse Case Admin l - UM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Wellness education Condition Management Milliman guidelines Medical Management Policies Database experience Lotus Notes Coordination of care PC Proficiency Disease Management +27

USD 58K+

Primary Nurse Case Admin l - CM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Wellness education Condition Management Milliman guidelines Medical Management Policies Database experience Lotus Notes Coordination of care PC Proficiency Disease Management +26

USD 58K+

Case Manager RN (Remote)
Work At Home-Georgia

Home healthcare Proprietary applications Telework Navigating multiple systems Healthcare Coordination Clinical resources Holistic approach Clinical Tools RN licensure +35

USD 54K+

Case Manager RN (Remote)
Work At Home-New York

Home health care coordination Proprietary applications Telework Navigating multiple systems RN license Clinical resources Holistic approach Clinical Tools Home Health +37

USD 66K+

Case Manager RN (Remote, Nevada RN licensure required)
Work At Home-Nevada

Home healthcare Proprietary applications Telework Navigating multiple systems Healthcare Coordination Clinical resources Holistic approach Clinical Tools RN licensure +35

USD 60K+

Holistic Health Specialist (Health Advocacy Solutions)
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Familiarity with ancillary services MCG Certification Wellness education Milliman guidelines Condition Management Medical Management Policies Lotus Notes Database experience Coordination of care +25

USD 58K+

Registered Nurse - RN - Case Management - Remote
Work At Home-North Carolina

Multi-systems navigation Clinical resources Holistic approach Clinical Tools Keyboarding Care Planning Policies and procedures Data Review Member engagement +25

USD 54K+

Care Manager RN (Remote)
Work At Home-Texas

Home healthcare Proprietary applications Telework Navigating multiple systems Healthcare Coordination Clinical resources Holistic approach Clinical Tools RN licensure +35

USD 60K+

Utilization Management Nurse Consultant (Remote)
Work At Home-Pennsylvania

Post-acute care Navigating multiple systems Coverage determination Benefit utilization Benefit management Clinical Criteria Acute care RN licensure Keyboarding +19

USD 58K+

Care Manager RN (Remote)
Work At Home-Mississippi

Home healthcare Proprietary applications Telework Navigating multiple systems Healthcare Coordination Clinical resources Holistic approach Clinical Tools RN licensure +35

USD 54K+

Complex Case Manager RN Pediatric - (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Pediatric case management Condition Management Dialectical behavior therapy Disease Processes Care Plan Development Cognitive Behavioral Therapy Cultural Competency Motivational interviewing Clinical Judgment +15

Senior Mid Full Time

USD 57K+

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