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13 fresh jobs found
Episodic Care Manager
Full Time Remote - North Carolina, United States Blue Cross NC logo Blue Cross NC
Medical necessity assessment Health care coordination Case review Clinical reviews Clinical evaluation Medical policy Medical necessity Clinical Documentation Clinical knowledge +7
Mid Full Time
USD 68K+
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Clinical Review Nurse - Prior Authorization
Remote-FL, United States Centene Corporation logo Centene Corporation
Utilization Medicare regulations Cost-effective care Service authorization Health management systems Medicaid regulations Health management Authorization requests Medical appropriateness +26
Mid Full Time
USD 52K+
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HMSA Intake Precert Care Manager - Remote Hawaii
Remote HI Honolulu 96813, United States Magellan Health logo Magellan Health  Remote-first
DSM V Telephone triage Clinical reviews Substance abuse Discharge planning Outpatient Care Triage Tracking Crisis Intervention +17
Mid Full Time
USD 58K+
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Behavioral Health Care Manager Remote, must be Licensed and Reside in California
Remote CA San Diego 92126, United States Magellan Health logo Magellan Health  Remote-first
Inpatient care DSM-5 DSM V Telephone triage Clinical reviews Substance abuse Discharge planning Outpatient Care Triage +19
Mid Full Time
USD 58K+
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Clinical Review Nurse - Prior Authorization
Remote-NY, United States Centene Corporation logo Centene Corporation
Service authorization Health management systems Health management Medicaid regulations Authorization requests Medical appropriateness Clinical reviews Clinical Information Clinical Review +21
Mid Full Time
USD 95K+
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Clinical Review Nurse - Prior Authorization
Remote-IL, United States Centene Corporation logo Centene Corporation
Service authorization Medical necessity analysis Medicare regulations Health management systems Medical appropriateness Health management Clinical reviews Authorization requests Medicaid regulations +22
Mid Full Time
USD 95K+
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Clinical Review Clinician - Appeals (RN)
Remote-TX, United States Centene Corporation logo Centene Corporation
Appeals process Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity Medical Records +23
Mid Full Time
USD 95K+
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Part Time Medical Director(Appeals Experience Preferred)
Dayton WFH, United States CareSource logo CareSource
Clinical case review Medical consultation Performance evaluations Systematic Thinking Data Sharing Clinical reviews Critical Listening NCQA Provider education +17
Exec Senior Part Time
USD 191K+
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Behavioral Health Care Manager Remote, must be Licensed and Reside in California
United States, United States Magellan Health logo Magellan Health  Remote-first
DSM-5 DSM V Clinical reviews Telephone triage Substance abuse Tracking Triage Crisis Intervention Discharge planning +17
Mid Full Time
USD 58K+
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Clinical Review Clinician - Appeals
Remote-MO, United States Centene Corporation logo Centene Corporation
Appeals processing Interdepartmental Collaboration Clinical data analysis Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity +25
Mid Full Time
USD 52K+
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Care Manager (CM - Adult) Field Based
Remote ID Pocatello 83201, United States Magellan Health logo Magellan Health  Remote-first
DSM V Telephone triage Clinical reviews Substance abuse Tracking Triage Crisis Intervention Discharge planning Care Coordination +16
Mid Full Time
USD 58K+
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Quality Clinical Reviewer, Licensed/Remote in PA (Cambria Cty)
Remote PA Johnstown 15901, United States Magellan Health logo Magellan Health  Remote-first
Treatment modalities Psychopharmacology Clinical reviews Accreditation Standards Psychology Regulatory Guidelines Behavioral healthcare Performance Measurement Clinical Documentation +13
Senior Mid Full Time
USD 64K+
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Clinical Solutions Specialist-Urology
REMOTE- New York, United States Medline Industries, LP logo Medline Industries, LP
Product trial Utilization reviews Clinical reviews Urology Customer Education Clinical Practice Clinical expertise Microsoft PowerPoint Microsoft Word +10
Mid Full Time
USD 85K+
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