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Clinical Review Remote Jobs

48 fresh jobs found

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

Centene Corporation

Health management systems Medicaid regulations Health management Utilization Clinical Review Medical necessity Acute care Discharge planning Medical Records +19

USD 52K+

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+

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

Centene Corporation

Utilization Health management systems Medicaid regulations Health management Medical necessity Clinical Review Acute care Discharge planning Medical Records +19

USD 95K+

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+

Sr. Nurse Reviewer - Provider Relations
Any city, MA, US, 99999

Gainwell Technologies

Interqual criteria Prepayment review Pre-admission screening Post payment review RN license InterQual Processes Provider Relations Clinical Review +30

Senior Full Time

USD 64K+

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

Centene Corporation

Utilization Medicare regulations Cost-effective care Service authorization Health management systems Medicaid regulations Health management Authorization requests Medical appropriateness +26

USD 52K+

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+

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

Centene Corporation

Healthcare Collaboration Medical appropriateness Substance abuse Treatment plans Provider education Discharge planning Clinical Review Utilization Review Treatment Planning +21

USD 52K+

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

Centene Corporation

RN licensure Health management systems UM Medicaid regulations Health management InterQual Acute care Discharge planning Clinical Review +22

USD 52K+

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

Centene Corporation

Service authorization Health management systems Health management Medicaid regulations Authorization requests Medical appropriateness Clinical reviews Clinical Information Clinical Review +21

USD 95K+

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

Centene Corporation

Medical appropriateness Healthcare Collaboration Substance abuse Treatment plans Discharge planning Clinical Review Utilization Review Prior authorization Medical management +20

USD 52K+

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

Centene Corporation

Education provision Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Prior authorization +20

USD 52K+

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+

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

Centene Corporation

Service authorization Medical necessity analysis Medicare regulations Health management systems Medical appropriateness Health management Clinical reviews Authorization requests Medicaid regulations +22

USD 95K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

Autism spectrum disorder Healthcare Provider Interaction Medical appropriateness Clinical Standards Applied Behavior Analysis Treatment plans Behavioral Analysis ABA Clinical Review +25

USD 95K+

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

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management Prior authorization +19

USD 52K+

Behavioral Health Care Coordinator (Outpatient Services)
Downers Grove (3500 Lacey Road), United States

Health Care Service Corporation

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

USD 60K+

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

Centene Corporation

Clinical licensure Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management +22

USD 95K+

IP Utilization Review Clinician - Behavioral Health
Remote-LA, United States

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management Prior authorization +18

USD 52K+

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

Centene Corporation

Appeals process Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity Medical Records +23

USD 95K+

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

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Provider education Substance abuse Clinical Review Discharge planning Treatment Planning Utilization Review +21

USD 52K+

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+

Supervisor, Utilization Management
Remote-OK, United States

Centene Corporation

UM Accreditation Standards Accreditation Clinical Review Medical management Prior authorization Performance monitoring Health Services Quality improvement +22

USD 73K+

Utilization Review Nurse
Remote

Medical necessity reviews Level of care reviews Evidence-Based Guidelines Clinical Guidelines Technology Platform RN licensure Clinical Practice Acute care Clinical Review +11

USD 70K+

Medical Director - South Central
Remote US, United States

Community Groups Grievance and appeals processes Outpatient services Post-acute services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Social determinants +85

Exec Senior Full Time

USD 223K+

Nurse Auditor
Remote US, United States

Medical necessity auditing Clinical audit Tricare Diagnosis coding Coding certification Medical record documentation Medical claims Medical Record Review CPT codes +49

USD 78K+

Senior Medical Coding Professional
Remote US, United States

Claims Life Cycle 3M Coding Software Chemotherapy Outpatient Surgery Ambulatory Payment Classification Infusion Radiation Oncology Coding certification OneNote +60

Senior Full Time

USD 71K+

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

Ensemble Health Partners

Healthcare Resource Utilization Clinical review criteria Medical necessity determination Medical Necessity Review Medical Record Review Denial Management Clinical Review Medical necessity Utilization Review +18

USD 57K+

Clinical Solutions Specialist
REMOTE- North Carolina, United States

Medline Industries, LP

Clinical practice adjustment Waste assessment Waste assessments Utilization reviews Presentation Development Medical Sales Clinical Review Clinical Practice Customer Education +15

USD 77K+

Physician Reviewer, Utilization Management
Remote

Workflow Tools Medical necessity criteria Evidence-Based Guidelines Peer-to-peer discussions Clinical Review Technology Platform Clinical Practice Clinical Acumen Utilization Review +13

Senior Full Time

USD 211K+

Sr Clinical Solutions Manager
REMOTE- Illinois, United States

Medline Industries, LP

Marketing campaign development Waste assessments Clinical program management Product Evaluation Clinical Review Clinical Practice Training and Development Clinical expertise Clinical trials +16

Senior Mid Full Time

USD 132K+

Clinical Review Clinician - Appeals
Remote-MO, United States

Centene Corporation

Appeals processing Interdepartmental Collaboration Clinical data analysis Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity +25

USD 52K+

Remote Clinical UM Pharmacist
Remote - NY, United States

Medical Policies Clinical communication Evidence-based medicine Clinical Review Prior authorization Pharmacy Microsoft Outlook Microsoft PowerPoint Outlook +8

USD 86K+

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

Centene Corporation

Education provision Medical appropriateness Clinical licensure Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review +19

USD 95K+

Director, Pharmacovigilance Physician
Remote (United States), United States

PTC Therapeutics, Inc.

Safety Surveillance Processes Medical Surveillance Safety Aggregate Reports Risk tracking GVP Safety reporting Signal detection ICH Guidelines Good Clinical Practice +27

Exec Senior Full Time

USD 250K+

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+

Registered Nurse with Coding Certificate - Remote in US
Any city, MS, US, 99999

Gainwell Technologies

AP-DRG HMS Auditing Systems CC CMS Requirements DRG validation Coding certification Coding reviews HMS Internet browsers +61

Senior Mid Full Time

USD 59K+

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+

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+

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+

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