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Clinical Review Remote Jobs

33 fresh jobs found

Remote RN Case Manager
Springfield, IL, United States

Medical and behavioral health assessments AI and predictive analytics Health navigation Psychosocial assessment Population health management Healthcare Management Clinical Review Health promotion Clinical Judgment +38

USD 75K+

Manager, Utilization Management
Remote-CA, United States

Centene Corporation

Holidays Report review Provider Communication Paid time off Medicaid Experience Guideline development Retrospective review UM Tuition reimbursement +51

USD 85K+

PAC Nurse
Remote

Project participation Patient status monitoring Inter-rater reliability Milliman Managed care regulations Evidence-based care guidelines URAC Ncqa standards Home health care +30

USD 72K+

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

Centene Corporation

Rehab EMR databases ICU Concurrent review Health management Clinical Review Utilization Medical necessity Medical management +31

USD 95K+

UM Administration Coordinator
Work at Home - Kentucky, United States

Correspondence Provider Communication Interviewing Technology Home Office Setup Internet Troubleshooting Policy Adherence Clerical tasks Medical Records Management Computational +74

Entry Full Time

USD 40K+

Product Incident Risk Management Expert
US-MD-Remote Location, United States

Agilent Technologies

Complaint investigation Safety databases navigation Clinical safety reporting Diagnostic review Health hazard evaluation Use error analysis Health Canada regulations EU MDR Clinical communication +40

Senior Mid Full Time

USD 121K+

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

Centene Corporation

Inpatient Services Education to Providers Provider collaboration Medical necessity evaluation Health management systems Concurrent review Health management Medicaid regulations Resource Utilization +33

USD 52K+

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

Centene Corporation

Education provision Healthcare provider coordination Clinical information documentation Authorization requests Health management systems Service authorization Medical appropriateness Health management Medicaid regulations +29

USD 52K+

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

Centene Corporation

Medical appropriateness Concurrent review Healthcare Collaboration Treatment plans Clinical Review Utilization Medical management Health Services Guidelines +23

USD 52K+

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

Centene Corporation

Health management systems Concurrent review Health management Medicaid regulations Clinical Review Utilization Medical necessity Medical management Health Services +21

USD 95K+

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

Centene Corporation

Healthcare provider coordination Clinical information documentation Health management systems Authorization requests Service authorization Medical appropriateness Health management Medicaid regulations Clinical reviews +27

USD 95K+

Clinical Review Clinician - Appeals
Remote-CA, United States

Centene Corporation

Case reviews Interdepartmental Collaboration Ncqa standards Medicaid regulations Clinical reviews Researching Clinical Review NCQA Medical necessity +27

USD 95K+

Utilization Review Clinician - Behavioral Health (Sat-Wed Shift)
Remote-FL, United States

Centene Corporation

Medical appropriateness Concurrent review Healthcare Collaboration Treatment plans Clinical Review Utilization Guidelines Health Services Medical management +23

USD 52K+

Clinical Solutions Specialist
REMOTE- California, United States

Medline Industries, LP

Clinical practice adjustment Waste assessment Clinical process enhancement Quality investigations Waste assessments Utilization reviews Clinical Solutions Clinical Review Medical Sales +19

USD 93K+

Part Time-Associate Medical Director(Required Weekends)
Dayton WFH, United States

Prior authorization reviews Clinical appeals support Clinical case review Medical consultation Performance evaluations Systematic Thinking Clinical appeals URAC Data Sharing +31

Senior Mid Part Time

USD 191K+

Clinical Program Director
United States

Cohere Health Remote-first

Measurable outcomes Clinical program development Inpatient care Evidence-Based Guidelines Clinical Strategy Clinical Guidelines Clinical Review Clinical programs Medical necessity +16

Exec Senior Full Time

USD 160K+

Remote Medical Director, Grievances & Appeals
Dayton WFH, United States

Clinical case review Medical consultation Performance evaluations Clinical appeals Systematic Thinking URAC Cultural Sensitivity Data Sharing Critical Listening +31

Exec Senior Full Time

USD 191K+

RN Clinical Review Clinician - Appeals
Remote-CA, United States

Centene Corporation

Medical Records Review Interdepartmental Collaboration Case reviews UM Ncqa standards Medicaid regulations Clinical reviews Researching Clinical Review +30

USD 52K+

Clinical Appeal Nurse - Remote $10K Sign on Bonus
United States

Tenet Healthcare

Patient accounting knowledge Electronic tools Medical necessity criteria Denials management ACE InterQual UB04 Patient Accounting Managed Care Contracts +32

USD 92K+

Senior Inpatient Clinical Research Specialist
United States

Cohere Health Remote-first

Payer um reviews Inpatient admission Ai optimization Clinical Review Clinical Intelligence Technology applications Medical necessity Acute care Agility +21

Senior Full Time

USD 75K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Healthcare Programs Retrospective review Concurrent review Accreditation Compliance Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity +24

USD 66K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Healthcare Programs Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity Acute care Prior authorization +23

USD 70K+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Orthopedic spine surgery Spine surgery Neurosurgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Review Clinical Intelligence Medical necessity +13

Senior Mid Full Time

USD 250K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

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

Senior Mid Full Time

USD 200K+

Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
Tennessee Work at Home, United States

The Cigna Group

Case conferences Medical licenses Board certifications Peer-to-peer discussions Cigna Ncqa standards Federal Laws Medical Review Clinical Review +21

Exec Senior Full Time

USD 203K+

Concurrent Utilization Review Nurse (Work from Home)
California, United States

Care transitions Education and collaboration Medical necessity determination Case assessment Authorization processes Compliance Documentation MCG InterQual Clinical Review +10

USD 74K+

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+

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+

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+

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+

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+

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