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Clinical Review Remote Jobs

22 fresh jobs found

Associate, Clinical Policy Specialist
Remote

Cohere Health Remote-first

Google Drive Healthcare policy Clinical Intelligence Clinical Review Medical terminology Healthcare Technology Clinical expertise Data Entry Microsoft Word +9

Entry Full Time

USD 50K+

Nurse Auditor 2
Remote US

Clinical audit Medical record documentation Coding certification Medical Record Review Medical claims CPT codes Clinical Review CPT Consumer Experiences +37

USD 69K+

Clinical DRG Auditor, Specialist (Remote Nurse in US)
Any city, ID, US, 99999

Gainwell Technologies

DRG Methodologies HMS Auditing Systems Clinical review judgment Clinical auditing Regulatory support MCC AP-DRG CC Internet browsers +57

Senior Mid Full Time

USD 59K+

Associate Medical Director, Cardiology
United States

Cohere Health Remote-first

Vascular medicine Clinical Decision Making Peer-to-peer discussions Evidence-Based Guidelines Software tools Clinical Intelligence Medical necessity Clinical Acumen Clinical Review +10

Senior Mid Full Time

USD 240K+

Clinical Quality Nurse Reviewer, Sr. Specialist - (RN Remote in US)
Any city, NC, US, 99999

Gainwell Technologies

Clinical quality review InterQual criteria Chart Audits Clinical criteria guidelines Productivity standards Medical Record Review RN license InterQual Clinical Criteria +28

Senior Full Time

USD 64K+

Dental Reviewer, Supervisor (Remote within Arkansas)
Arkansas, United States - Remote

Dental review Web navigation Dental hygiene Strong organizational Medical record abstracting Human services Clinical Review Clinical assessment Public Sector +21

Senior Mid Full Time

USD 71K+

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+

Medical Director - Northeast Region
Remote US

Commercial health insurance Post-acute services Grievance and appeals processes Outpatient services Coding practices Clinical group practice management Judgement Inpatient rehabilitation Hospitalist +80

Exec Senior Full Time

USD 199K+

Prior Authorization Pharmacist
Remote

Clinical audits Peer-to-peer calls Pharmacy Practice Prior authorizations Clinical Criteria Clinical Review Technology Platform Prior authorization Pharmaceuticals +11

USD 108K+

Medical Director- South Central
Remote US

Post-acute services Clinical group practice management Clinical Standards Grievance and appeals processes Outpatient services Coding practices Inpatient rehabilitation Medical background Clinical reference materials +78

Exec Senior Full Time

USD 199K+

Utilization Management Liaison Lead
Remote

Insurance experience Workflow improvement Clinical Review Performance Indicators Lean Six Sigma Technology Platform Administrative Tasks KPIs Utilization management +24

Senior Mid Full Time

USD 48K+

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+

Medical Director - Acute Rehab Team
Remote US

Acute inpatient rehabilitation Humana policies Clinical reference materials Medical interpretation Medical background CMS policies Hospitalist Inpatient rehabilitation National Guidelines +52

Exec Senior Full Time

USD 199K+

Dental UM Supervisor (Remote within Arkansas)
Little Rock, AR, United States

Dental hygiene Medical record abstracting Internet navigation Clinical Review Clinical assessment Utilization management Clinical expertise MS Office Critical thinking

Senior Mid Full Time

USD 71K+

Associate Manager, Clinical Review Nurse (Remote)
Any city, TX, US, 99999

Gainwell Technologies

Clinical review judgment APR-DRG MS-DRG CCS Quality Metrics DRG CPC Clinical Criteria RN license +36

Senior Mid Full Time

USD 69K+

Operating Effectiveness Senior Analyst - eviCore - Remote
Tennessee Work at Home

The Cigna Group

Pathway designer Clinical knowledge integration Adobe Pro DITA Call center Operations Clinical Review Health Services Software Applications Regulatory standards +31

Senior Mid Full Time

USD 60K+

Senior Medical Coding Professional
Remote US

Guideline research Coding certification Analyzing CPT coding Medical Coding Clinical Review MS PowerPoint Bilingual English/Spanish Consumer Experiences +45

Senior Full Time

USD 63K+

EAP Consultant, Senior (Remote U.S.)
United States - Remote

Team performance Workplace legislation Human behavior Clinical risk assessments Management consultation Clinical Consultation Action plans Clinical assessments Clinical Review +29

Senior Mid Full Time

USD 60K+

Associate Medical Director, Orthopedic Spine Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Software tools Evidence-Based Guidelines Operational Improvements Clinical Intelligence Clinical Acumen Clinical Review Medical necessity +8

Senior Mid Full Time

USD 240K+

Associate Medical Director, Pain Management
United States

Cohere Health Remote-first

Pain management Peer-to-peer discussions Evidence-Based Guidelines Software tools Operational Improvements Clinical Intelligence Clinical Acumen Technology Proficiency Clinical Review +10

Senior Mid Full Time

USD 240K+

Associate, Affordability
Remote

Healthcare Consulting Clinical Review Technology Platform Utilization management Six Sigma Lean Health Insurance Risk mitigation Professional Development +19

USD 88K+

Clinical Reviewer-Immediate Advocacy/Quality of Care (RN), Remote
United States - Remote

Medical record abstracting Medical Record Review Clinical Review Clinical assessment Public Sector Medical Records Healthcare Knowledge RN Care management +12

USD 44K+

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