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Clinical Judgment Remote Jobs

50 fresh jobs found

Prior Authorization Clinician RN
Work At Home-Oklahoma, United States

Precertification Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +18

USD 52K+

Primary Nurse Case Admin I ONSITE - Dallas
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Wellness education Milliman guidelines Coordination of care Lotus Notes Medical Management Policies UM CM Database experience Condition Management +34

USD 60K+

Chronic Care Management Registered Nurse (Remote)
Remote

Vesta Healthcare

Remote patient care Partnerships with home care agencies Mobile technologies Care Plan Development Data Integrations Remote patient monitoring Home Care Nurse Practitioner Chronic care management +17

USD 85K+

Utilization Management Nurse Consultant
Work At Home-Michigan, United States

CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20

Entry Mid Full Time

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Kansas, United States

CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20

Entry Mid Full Time

USD 52K+

Remote Clinical Case Manager (Social Worker)
Rockford, IL, United States

Healthcare Management Motivational interviewing Clinical Judgment Case Management Verbal communication Written communication Time Management Organizational Data analysis +1

Senior Mid Full Time

USD 60K+

Utilization Management Nurse Consultant
Work At Home-Illinois, United States

Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication Medical necessity +25

USD 64K+

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

Health Care Service Corporation

Wellness education Lotus Notes Coordination of care Milliman guidelines Medical Management Policies UM CM Database experience Condition Management +33

USD 60K+

Utilization Management Clinical Consultant - Remote Kentucky
Work At Home-Kentucky, United States

Healthcare services coordination Triage support Crisis support Clinical Practice Guidelines Navigating multiple systems Keyboarding Benefit management Benefit utilization Evidence-Based Care +24

USD 52K+

Clinical Case Manager Behavioral Health
Work At Home-Texas, United States

Community resource identification Provider coordination Bilingual Spanish and English Clinical Tools RN license Data Review Care Planning Telephonic Communication Crisis Intervention +32

USD 60K+

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

Health Care Service Corporation

Wellness education Milliman guidelines Coordination of care Lotus Notes Medical Management Policies UM CM Database experience Condition Management +34

USD 60K+

Utilization Management Nurse Consultant
Work At Home-New York, United States

Healthcare services coordination Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication +25

USD 64K+

Utilization Management Nurse Consultant
Work At Home-Florida, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +21

USD 52K+

Case Manager RN (Remote)
Work At Home-Florida, United States

Home healthcare Clinical models Proprietary applications Navigating multiple systems Telework Clinical resources Holistic approach Keyboarding Clinical Tools +38

USD 54K+

Clinical Case Manager Behavioral Health DSNP- Spanish Speaking
Work At Home - Utah, United States

Substance abuse knowledge Clinical Case Management Substance abuse disorders Provider coordination Concurrent review Bilingual Spanish and English Spanish Speaking Community Resource Coordination Substance abuse +32

USD 54K+

Case Manager RN- Pennsylvania
Work At Home-Pennsylvania, United States

Emergency department Integrative functions Clinical resources Long Term Care Holistic approach Clinical Tools Data Review Member engagement RN licensure +24

USD 60K+

Utilization Management Clinician Behavioral Health
Work At Home-Pennsylvania, United States

Navigating systems Clinical Practice Guidelines Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Mental health services Evidence-Based Care +23

USD 60K+

Utilization Management Nurse Consultant
Work At Home-North Carolina, United States

Multi-systems navigation Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Electronic Medical Records +24

USD 52K+

Wellbeing Health Advisor - OK
Tulsa Oklahoma HQ (1400 S. Boston Avenue), United States

Health Care Service Corporation

Medical Management Policies Milliman guidelines Database experience Condition Management PC Proficiency Clinical Care PC Clinical Practice Clinical Judgment +22

USD 60K+

Medical Director - Pediatric Infectious Disease - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Evidence-Based Decision Making Evidence-based medical reviews Case Management Software Automated processes Computer Applications Federal Laws Healthcare Regulations Medical necessity +22

Exec Senior Full Time

USD 203K+

Virtual Urgent Care Clinician (Overnight Shifts)
Remote, United States

Family Nurse Practitioner Digital-first healthcare Synchronous video Empathetic care Virtual medicine Resourcefulness Family Medicine Urgent care Acute care +14

Senior Mid Full Time

USD 156K+

Medical Director- Radiation Oncology - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Medical Case Management Evidence-based reviews Case Management Software Evidence-Based Decision Making Evidence-based medical reviews Automated processes Computer Applications Federal Laws +30

Exec Senior Full Time

USD 203K+

Medical Director - Clinical Biochemical Genetics or Clinical Genetics - EviCore
Florida Work at Home, United States

The Cigna Group

Clinical genetics Clinical biochemical genetics Medical case reviews Evidence-Based Decision Making Case Management Software Evidence-based medical reviews Automated processes Evidence-based medicine Computer Applications +25

Exec Senior Full Time

USD 203K+

Medical Director - Pediatric Radiology - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Evidence-based reviews Evidence-Based Decision Making Case Management Software Evidence-based medical reviews Automated processes Computer Applications Federal Laws Healthcare Regulations +23

Exec Senior Full Time

USD 203K+

Utilization Management Nurse Consultant
Work At Home-Nevada, United States

Clinical call center Clinical Judgement Concurrent review Long Term Care Benefit management Benefit utilization Clinical Criteria Home Health Disease Management +19

USD 58K+

Clinical Case Manager Behavioral Health DSNP
Work At Home-Pennsylvania, United States

Provider coordination Substance abuse disorders Licensed Clinical Professional Counselor Licensed Mental Health Counselor Technological Clinical Tools Substance abuse Data Review Licensed Marriage and Family Therapist +26

USD 60K+

Utilization Management Nurse Consultant
Work At Home-Ohio, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +30

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania, United States

Keyboarding Coverage determination Healthcare Coordination Benefit utilization Benefit management Computer Systems Clinical Criteria Telephonic Communication RN licensure +25

USD 58K+

Clinical Case Manager Behavioral Health
Work At Home-Illinois, United States

Psychosocial services Provider coordination Telephonic assessment Navigating multiple systems Holistic approach Clinical Tools Data Review Clinical Guidelines Care Planning +42

USD 66K+

Clinical Supervisor
US CA Fremont, United States

Center for Autism and Related Disorders (CARD)

Behavioral supervision Applied Behavior Analysis Clinical Judgment Treatment Planning Coaching Data analysis Training

USD 30K+

Virtual Primary Care Physician (Spanish Fluency)
Remote, United States

Digital healthcare Data-Driven Care Spanish fluency Empathetic care Operational Rigor Digital-first healthcare Synchronous video Virtual medicine Resourcefulness +21

USD 276K+

Virtual Primary Care Nurse Practitioner (Late Night Shifts)
Remote, United States

Digital healthcare Data-Driven Care Patient management Synchronous video Virtual medicine Empathetic care Digital-first healthcare Operational Rigor Resourcefulness +20

Senior Mid Full Time

USD 156K+

Virtual Primary Care Nurse Practitioner
Remote, United States

Digital healthcare Data-Driven Care Patient management Synchronous video Virtual medicine Empathetic care Digital-first healthcare Operational Rigor Resourcefulness +20

Senior Mid Full Time

USD 156K+

Virtual Primary Care Physician (Overnight Shifts, Spanish Fluency)
Remote, United States

Synchronous communication Patient-centered care Data-Driven Care Asynchronous communication Spanish fluency Digital-first healthcare Synchronous video Operational Rigor Virtual medicine +22

USD 276K+

Virtual Primary Care Physician (Overnight Shifts)
Remote, United States

Digital-first healthcare Synchronous video Virtual medicine Operational Rigor Empathetic care Resourcefulness Family Medicine Technology Utilization Cultural Sensitivity +18

USD 276K+

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+

Virtual Urgent Care Clinician
Remote, United States

Synchronous video Digital-first healthcare Virtual medicine Empathetic care Resourcefulness Family Medicine Acute care Urgent care Clinical Judgment +13

Senior Mid Full Time

USD 156K+

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+

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+

Medical Case Manager - Remote (Harrisburg, PA area)
PA, Working at Home - Pennsylvania, United States

Highmark Health

Medical Case Management Care Plan Development Resource Coordination Healthcare Coordination Interdisciplinary Collaboration Telephonic Communication Community Resources Clinical Judgment Social Work +20

USD 57K+

Pre-Authorization Registered Nurse
Remote US, United States

MHK CGX Medical management systems MAccess Rehab Health Plan Experience MCG InterQual Medical necessity +49

USD 71K+

Medical Director - EviCore
Florida Work at Home, United States

The Cigna Group

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

Exec Senior Full Time

USD 196K+

Clinical Care Navigator
Remote

Crisis assessment Psycho education Crisis support Solution-focused approaches Professional documentation Mindfulness Safety Planning Ethical Standards Tech-savvy +33

USD 66K+

Clinical Coding Appeals Nurse
Remote, GA, United States

Appeal letter drafting Clinical coding ICD-9 Intelligent Automation NCCI Medical Record Review Workflow Orchestration Pcs Revenue Cycle +11

USD 71K+

Care Manager RN
Work At Home-Colorado

High-Speed Internet Clinical Tools RN license Data Review Telephonic Communication Member engagement Policies and procedures RN licensure Acute care +18

USD 60K+

Clinical Supervisor Remote PT
US CA Simi Valley, United States

Center for Autism and Related Disorders (CARD)

Applied Behavior Analysis Productivity Clinical Judgment Treatment Planning Coaching Data analysis Training Collaboration Communication

USD 76K+

Primary Care Nurse Practitioner (Hybrid, Part-Time)
Remote, United States

Digital healthcare Patient management Empathetic care Digital-first healthcare Synchronous video Operational Rigor Virtual medicine Data-Driven Care Resourcefulness +20

Senior Mid Part Time

USD 156K+

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+

Clinical Supervisor Remote
US CA Remote, United States

Center for Autism and Related Disorders (CARD)

Applied Behavior Analysis Behavioral Analysis Productivity Clinical Judgment Treatment Planning Telehealth Coaching Training Collaboration +1

USD 30K+

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

Ob-gyn Maternity Infertility Women's Health Telephonic case management Integrative functions Clinical resources Clinical Tools Holistic approach +24

USD 54K+

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