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Clinical Review Remote Jobs

30 fresh jobs found

Clinical Review Clinician - Appeals (RN)
Remote-TX, United States

Centene Corporation

Clinical data analysis Appeals processing Interdepartmental Collaboration Clinical reviews Ncqa standards Medicaid regulations Clinical Review Appeals Medical necessity +18

USD 95K+

Clinical Review Nurse - Concurrent Review (RN)
Remote-TX, United States

Centene Corporation

NICU experience Health management systems Health management Medicaid regulations Clinical Review Acute care Discharge planning Medical necessity Medical Records +16

USD 95K+

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

The Cigna Group

Case conferences Medical care management Board certification Educational training Ncqa standards Peer-to-peer discussions Medical Review Quality of care Federal Laws +21

Exec Senior Full Time

USD 203K+

Clinical Review Nurse - Prior Authorization
Getzville-105 Crosspoint Pkwy (11106), United States

Centene Corporation

Clinical reviews Authorization requests Health management Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Acute care +18

USD 95K+

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

Centene Corporation

Health management Health management systems Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical Records +15

USD 52K+

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

Centene Corporation

Clinical reviews Health management Authorization requests Medical appropriateness Health management systems Medicaid regulations Clinical Review Medical necessity Prior authorization +17

USD 95K+

Supervisor, Utilization Management
Remote-NC, United States

Centene Corporation

Regulations knowledge UM Accreditation Standards Accreditation Clinical Review Procedures Health Services Prior authorization Medical management +17

USD 73K+

Behavioral Health Care Coordinator
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Contract Interpretation Database experience Clinical Review PC Medical necessity Utilization Review Registered Nurse Database Clinical Experience +13

USD 60K+

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

Centene Corporation

Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical management Clinical knowledge Utilization management +9

USD 93K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Retrospective review Concurrent review Accreditation Compliance Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes +20

USD 70K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Concurrent review Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes Clinical Review Medical necessity Utilization Review +18

USD 66K+

Clinical Review Clinician - Appeals
Remote-NY, United States

Centene Corporation

Clinical reviews Appeals processing Clinical data analysis Interdepartmental Collaboration Ncqa standards Medicaid regulations Appeals Clinical Review Medical necessity +19

USD 52K+

Medical Director - Southeast Region
Remote US, United States

Post-acute services Outpatient services Grievance and appeals processes Clinical group practice management Inpatient rehabilitation Commercial health insurance Coding practices Medical background Hospitalist +82

Exec Senior Full Time

USD 223K+

Utilization Review Nurse Consultant - Oncology and Transplant
Work At Home-Arizona, United States

Evidence-based criteria Transplant Clinical call center Concurrent review Clinical Practice Guidelines Telephone Communication Navigating multiple systems Clinical Criteria Disease Management +21

Entry Mid Full Time

USD 52K+

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

Centene Corporation

Education provision Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Utilization Review Discharge planning Health Services +17

USD 52K+

Virtual Utilization Review Specialist
Work at Home - Akron - OH, United States

Ensemble Health Partners

Healthcare Resource Management Clinical review criteria Medical necessity determination Medical Necessity Review Denial Management Clinical Review Medical necessity Color Utilization Review +15

USD 70K+

Pharmacy Technician - Prior Authorization - Work From Home
Work At Home-Arizona, United States

Pharmacy Technician Certification Windows-based Software Computerized Pharmacy Systems Medication therapy management Pharmacist Benefits Verification Pharmacy services Pharmacy Technician Clinical Criteria +28

USD 36K+

Remote RN Case Manager
St. Louis, MO, United States

Medical Assessments Behavioral health assessments HMO Healthcare Management Community Health Telephonic Outreach Motivational interviewing Clinical Review Predictive Analytics +15

Senior Mid Full Time

USD 70K+

Remote RN Case Manager
Springfield, IL, United States

Medical Assessments Behavioral health assessments HMO Healthcare navigation Healthcare Management Community Health Telephonic Outreach Motivational interviewing Clinical Review +16

Senior Mid Full Time

USD 70K+

Remote RN Case Manager
Rockford, IL, United States

Medical Assessments Behavioral health assessments HMO Healthcare navigation Healthcare Management Community Health Telephonic Outreach Motivational interviewing Clinical Review +16

Senior Mid Full Time

USD 70K+

Remote RN Case Manager
Chicago, IL, United States

Medical Assessments Behavioral health assessments HMO Healthcare Management Community Health Telephonic Outreach Motivational interviewing Clinical Review Predictive Analytics +15

Senior Mid Full Time

USD 70K+

Auditor Clinical Validation DRG
Remote, United States

Chart validation Medical claims billing Coding Principles Audit tools Clinical coding Payment Coding accuracy DRG ICD-9 +34

USD 44K+

Medical Director - Acute Rehab Team
Remote US, United States

Rehab Inpatient rehabilitation Medical background Hospitalist Clinical reference materials Medical interpretation CMS policies Family practice National Guidelines +55

Exec Senior Full Time

USD 223K+

Clinical Solutions Specialist
REMOTE- California, United States

Medline Industries, LP

Clinical practice adjustment Waste assessment Waste assessments Presentation Development Medical Sales Clinical Review Clinical Practice Customer Education Clinical support +14

USD 93K+

Medical Director, Clinical Policy
United States

Cohere Health Remote-first

Clinical writing Clinical Policy Clinical programs Clinical Strategy Scientific research Clinical Guidelines Clinical Intelligence Clinical Review Healthcare policy +17

Exec Senior Full Time

USD 250K+

Utilization Management Clinical Supervisor
Work From Home - AZ, United States

Virtual collaboration Clinical Review Microsoft Applications HCPCS CPT Leadership Development Microsoft Teams Performance monitoring Utilization management +25

USD 55K+

Clinical Review Rep
WA Other Telecommuter, United States

Premera Blue Cross

Facets CCA Express scripts Clinical Review Medical terminology Pharmacy Prioritization Time Management Microsoft Office +5

Entry Full Time

USD 46K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Evidence-Based Guidelines Peer-to-peer discussions Software tools Clinical Review Medical necessity Clinical Intelligence Clinical Acumen Utilization Review +12

Senior Mid Full Time

USD 200K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Evidence-Based Guidelines Peer-to-peer discussions Clinical Decision Making Software tools Clinical Review Medical necessity Clinical Intelligence +12

Senior Mid Full Time

USD 200K+

Physician Reviewer, Utilization Management
Remote

Medical necessity criteria Workflow Tools Evidence-Based Guidelines Clinical Review Clinical Acumen Technology Platform Utilization Review Clinical Practice Utilization management +11

Senior Full Time

USD 211K+

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