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Clinical Review Remote Jobs

38 fresh jobs found

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+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity Clinical Acumen Utilization Review +11

Senior Mid Full Time

USD 200K+

RC Appellate Clinician - Remote
United States

Tenet Healthcare

Electronic tools Medical necessity criteria ACE Denials management UB04 Patient Accounting InterQual Managed Care Contracts EOB +29

USD 92K+

Senior Clinical Review Nurse - Prior Authorization
Remote-NY, United States

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Clinical Information Clinical Review +25

Senior Mid Full Time

USD 60K+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Neurosurgery Orthopedic surgery Spine surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity +14

Senior Mid Full Time

USD 250K+

RN Clinical Review Clinician_Appeals
Remote-CA, United States

Centene Corporation

Appeals processes Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations Researching NCQA Clinical Review Guidelines +27

USD 95K+

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+

Clinical Review Nurse - Concurrent Review
Remote-NY, United States

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Medical necessity Clinical Review Discharge planning Utilization Acute care +20

USD 95K+

Clinical Review Nurse - Prior Authorization
Remote-CA, United States

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Guidelines Clinical Information +23

USD 95K+

Clinical Review Nurse - Concurrent Review
Remote-CA, United States

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Clinical Review Medical necessity Discharge planning Utilization Acute care +20

USD 95K+

Director-Utilization Management
Carlsbad, California, United States

Acadia Healthcare

Staff management Clinical Review Clinical Experience Utilization management Performance Management Patient care Regulatory Compliance Collaboration Communication

Exec Senior Full Time

USD 83K+

Clinical Review Nurse - Concurrent Review
Remote-FL, United States

Centene Corporation

TruCare Health management systems InterQual Guidelines Health management Medicaid regulations Clinical Review Medical necessity Discharge planning +22

USD 52K+

Clinical Review Nurse - Prior Authorization (RN)
Remote-CA, United States

Centene Corporation

RN licensure Service authorization Medical appropriateness Authorization requests Guidelines Clinical reviews Health management systems Medicaid regulations Health management +24

USD 95K+

Utilization Review Clinician - Behavioral Health
Remote-FL, United States

Centene Corporation

Guidelines Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Utilization Review +21

USD 52K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

ABA services Autism spectrum disorder Guidelines Medical appropriateness Behavioral Analysis Healthcare Provider Interaction Clinical Standards Applied Behavior Analysis Treatment plans +29

USD 95K+

Utilization Review Clinician-Behavioral Health
Remote-IL, United States

Centene Corporation

Education provision Outpatient Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Utilization Clinical Review Discharge planning +23

USD 52K+

Clinical Review Therapist - Physical Health
Remote-TX, United States

Centene Corporation

Therapy regulations Best Practice Standards Therapy Services Healthcare provider collaboration Guidelines Durable Medical Equipment Documentation standards Clinical reviews Clinical Training +20

USD 108K+

Clinical Review Nurse - Concurrent Review
Remote-AZ, United States

Centene Corporation

Health management systems Health management Medicaid regulations Utilization Medical necessity Clinical Review Discharge planning Acute care Medical Records +20

USD 52K+

Genetic Counselor Clinical Reviewer - EviCore - Remote
Tennessee Work at Home, United States

The Cigna Group

Pediatric genetics Perinatal genetics Adult genetics Cigna Genetic counseling Medical Review Health education Clinical Review Utilization Review +19

USD 71K+

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+

Clinical Coding and OASIS Review Manager
Austin, TX 78701 | 30.266876622 | -97.7441039

BAYADA Home Health Care

Medicare pdgm billing PDGM OASIS CMS guidelines Home health care ICD-10 Coding Telephone Home Care Clinical Review +10

USD 74K+

Clinical Coding and OASIS Review Manager
Pennsauken, NJ 08109 | 39.950866919 | -75.048664024

BAYADA Home Health Care

Coding review PDGM Home health coding OASIS Medicare pdgm billing CMS guidelines Home health care ICD-10 Coding Home Care +13

USD 74K+

Sr Clinical Solutions Spec-Vascular Access
REMOTE- Ohio, United States

Medline Industries, LP

Clinical process enhancement Bedside clinical experience Quality investigations Waste assessments Utilization reviews Workshop coordination Clinical presentations Infection Prevention Vascular access +17

Senior Full Time

USD 87K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Peer-to-peer discussions Clinical Decision Making Evidence-Based Guidelines Software tools Gastroenterology Clinical Intelligence Patient outcomes +18

Senior Mid Full Time

USD 200K+

Utilization Review Clinician - Behavioral Health
Remote-NC, United States

Centene Corporation

Education provision Healthcare Collaboration Medical appropriateness Utilization Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review +21

USD 52K+

Auditor Clinical Validation OPSP Clinical
Remote, United States

CMS security Clinical chart validation Medical record coding Cotiviti encoder Coding Principles Payer reimbursement Healthcare Auditing Billing guidelines Technological improvements +36

Senior Mid Full Time

USD 44K+

Remote Clinical Case Manager - LCSW (Social Worker)
Evansville, IN, United States

Medical assessments PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Telephonic Outreach Clinical Judgment +20

Senior Mid Full Time

USD 70K+

Remote Clinical Case Manager - LCSW (Social Worker)
Indianapolis, IN, United States

PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review Motivational interviewing +19

Senior Mid Full Time

USD 70K+

Remote Clinical Case Manager - LCSW (Social Worker)
Cedar Rapids, IA, United States

PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review Motivational interviewing +19

Senior Mid Full Time

USD 70K+

Remote Clinical Case Manager - LCSW (Social Worker)
Peoria, IL, United States

PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review Motivational interviewing +19

Senior Mid Full Time

USD 70K+

Remote Clinical Case Manager - LCSW (Social Worker)
Madison, WI, United States

PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review Motivational interviewing +19

Senior Mid Full Time

USD 70K+

Remote Clinical Case Manager - LCSW (Social Worker)
Milwaukee, WI, United States

EMR navigation PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review +18

Senior Mid Full Time

USD 70K+

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

PDF Behavioral health assessments LCPC HMO Healthcare Management LPC Clinical Judgment Clinical Review Motivational interviewing +19

Senior Mid Full Time

USD 70K+

Medical Coding Auditor
Remote US, United States

Audit validation Evaluation & management coding Diagnosis coding Medical record documentation Clinical Review Coding Guidelines Medical Coding Validation HIPAA Compliance +33

USD 59K+

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+

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 - 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+

UM Administration Coordinator
Work at Home - Florida, United States

Clinical Requests CGX Computations ICD-10 codes ICD Clinical Review Electronic Medical Records Eligibility verification Utilization Review +51

USD 40K+

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