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Guidelines Remote Jobs

53 fresh jobs found

Senior Pharmacy Resolution Specialist
Remote-MI, United States

Centene Corporation

Pharmacy retail Authorization requests Audit Preparation Pharmacy operations Pharmacy Technician Data gathering Guidelines Prior authorization Medical management +18

Senior Mid Full Time

USD 64K+

Care Coordinator II
Remote-NY, United States

Centene Corporation

Service assessments Education on Benefits Referral management Member Outreach Service plan Home visits Service Assessment Guidelines Regulatory Guidelines +18

USD 55K+

Medical Policy Analyst
Remote-MO, United States

Centene Corporation

Medical literature research Abuse management Medical policy development Clinical Practice Guidelines Technology assessments Waste management Evidence-based medicine Fraud Management Payment Integrity +18

Entry Mid Full Time

USD 68K+

Risk Adjustment Coder
Remote-FL, United States

Centene Corporation

HCC Outpatient CMS guidelines Abstracting ICD-10 codes Guidelines Risk Adjustment Medical Records ICD-10 +10

USD 77K+

Contract Implementation Analyst
Remote-LA, United States

Centene Corporation

Contract implementation Provider information system Provider contracts Amisys UAT Government programs Claims payment Claims analysis UAT testing +24

Entry Mid Full Time

USD 44K+

Senior LTSS Service Care Manager (RN)
Austin-13620 FM 620 Building C Suite 300 (11121), United States

Centene Corporation

Medicaid health assessments Personalized care plan Member advocacy Service authorization Continuum of care Service plan Quality care Long Term Care Health Assessments +38

Senior Full Time

USD 127K+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Clinical Information Clinical Review +25

Senior Mid Full Time

USD 60K+

Data Governance Specialist
Alaska

Standards Data Stewardship Data Systems Partnership Guidelines Information systems Policy Development Public health Training Development +19

USD 81K+

Regulatory Operations Analyst II - IDR Operations
Remote-MO, United States

Centene Corporation

Regulatory research Amisys Arbitration Dispute resolution Guidelines Policy analysis Tracking Legal research CMS +24

USD 95K+

RN Clinical Review Clinician_Appeals
Remote-CA, United States

Centene Corporation

Appeals processes Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations Researching NCQA Clinical Review Guidelines +27

USD 95K+

Senior LTSS Service Care Manager (RN)
Remote-TX, United States

Centene Corporation

Long-term care planning Medicaid health assessments Community Resource Coordination Personalized care plan Member advocacy Service authorization Service plan Continuum of care Quality care +39

Senior Full Time

USD 127K+

Contract Negotiator II
Remote-NC, United States

Centene Corporation

Provider experience Contract Analysis Contract Compliance Guidelines Claims Adjudication Adjudication Provider Relations Health Plan Healthcare administration +22

USD 55K+

Senior LTSS Service Care Manager (RN)
Corpus Christi - 711 N. Carancahua St., Ste 600 (Superior) (10086), United States

Centene Corporation

Rehab Personalized care plan Member advocacy ICU Service authorization Service plan Continuum of care Long Term Care Service coordination +44

Senior Full Time

USD 70K+

Community Relations Representative I - Virtual
Remote-NC, United States

Centene Corporation

Community relations Community outreach Guidelines HEDIS Competitive analysis Managed Care Health care Outreach Medicaid +16

USD 55K+

Care Coordinator II
Remote-NJ, United States

Centene Corporation

Service assessments Education on Benefits Service plan Member Outreach Service coordination Home visits Guidelines Regulatory Guidelines Health Plan +17

Entry Mid Full Time

USD 55K+

Certified Medical Assistant | Remote | $17/hour | Starts 4/17/25
United States

Medical Assistant Guidelines Compassion Electronic Medical Records Protocols Medical terminology Microsoft Outlook Data Entry Microsoft Word +3

USD 34K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Medical necessity Clinical Review Discharge planning Utilization Acute care +20

USD 95K+

Authorization Specialist II
Remote-FL, United States

Centene Corporation

Healthcare eligibility Healthcare Policies Authorization processes Authorization requests Insurance coverage Researching Guidelines Adjudication Utilization +19

Entry Mid Full Time

USD 55K+

Community Relations Coordinator
Remote-DE, United States

Centene Corporation

Healthcare Programs Community relations Guidelines Community outreach Event Coordination Regulatory Guidelines Health education Health Plan Relationship Development +15

USD 77K+

LTSS Assessor RN
Remote-NY, United States

Centene Corporation

Clinical guidelines compliance Service plan Personalized care plan Community resources coordination Member advocacy UAS Healthcare provider collaboration Service authorization Continuum of care +34

USD 70K+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Guidelines Clinical Information +23

USD 95K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Clinical Review Medical necessity Discharge planning Utilization Acute care +20

USD 95K+

TeleHealth Registered Nurse - Registry
Remote-TX, United States

Centene Corporation

Obstetrics Health management Patient Assessment Guidelines Care Planning Clinical Information Home Health Triage Medical management +16

USD 95K+

Communications Specialist
Remote-FL, United States

Centene Corporation

Guidelines InDesign Journalism Adobe Creative Suite Graphic Design Cross-functional Teams Adobe Health Insurance MS Office +10

USD 95K+

Care Coordinator III
Remote-IL, United States

Centene Corporation

Service plan Service assessments Education on Benefits Member Outreach Home visits Guidelines Service plans Social Work Clinical Experience +24

Senior Mid Full Time

USD 68K+

Retention Call Center Representative - Bilingual
Remote-NY, United States

Centene Corporation

Effective Business Communication Lotus Notes Guidelines Customer Care Healthcare experience Effective Communication Procedures Call Center Business Analysis +23

USD 30K+

Senior Application Development Engineer
Remote-MO, United States

Centene Corporation

Third-party development Data access logic Service interfaces Service messages Business logic SOA components Programming concepts Guidelines Process Flows +35

Senior Mid Full Time

USD 85K+

Care Coordinator II
Remote-AR, United States

Centene Corporation

Service assessments Education on Benefits Member Outreach Guidelines Home visits Service Assessment Care Coordination Referrals Care management +15

USD 55K+

Supervisor, Behavioral Health Utilization Management
Remote-FL, United States

Centene Corporation

Regulations Compliance UM Guidelines Accreditation Standards Clinical Supervision Medical necessity Utilization Accreditation Utilization Review +28

USD 73K+

Supervisor, Provider Network
Remote-TX, United States

Centene Corporation

Network account management Quality Initiatives Provider Contracting Claims payment Guidelines Health Plan Procedures Claims Supervisory +19

USD 55K+

Housing Management Specialist II
Remote-NV, United States

Centene Corporation

Housing management Permanent supportive housing Transitional housing programs Fair housing Client assessment Eligibility Determination Housing regulations Community collaboration Continuum of care +35

USD 55K+

Clinical Investigator I (Special Investigation Unit)
Remote-FL, United States

Centene Corporation

Claims data analysis Provider Billing Billing practices Policy compliance Provider education Guidelines Information Management Medical Coding Clinical Experience +19

USD 55K+

Contract Negotiator II
Remote-CA, United States

Centene Corporation

Guidelines Provider experience Contract Analysis Claims Adjudication Contract Compliance Adjudication Provider Relations Healthcare administration Health Plan +21

USD 52K+

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

Centene Corporation

TruCare Health management systems InterQual Guidelines Health management Medicaid regulations Clinical Review Medical necessity Discharge planning +22

USD 52K+

Care Management Support Coordinator II
Remote-FL, United States

Centene Corporation

Guidelines Social determinants Social Determinants of Health Health Plan Customer Care Referrals Community Resources Procedures Care management +18

Entry Mid Full Time

USD 55K+

Director, Business Operations
Remote-MO, United States

Centene Corporation

Guidelines Healthcare operations Lean Six Sigma Contact center Medical management PMP Healthcare experience Digital technology Operations Management +33

Exec Senior Full Time

USD 116K+

Clinical Review Nurse - Prior Authorization (RN)
Remote-CA, United States

Centene Corporation

RN licensure Service authorization Medical appropriateness Authorization requests Guidelines Clinical reviews Health management systems Medicaid regulations Health management +24

USD 95K+

Authorization Specialist I
Remote-TX, United States

Centene Corporation

Healthcare eligibility Authorization processes Authorization requests Guidelines Utilization Tracking Prior authorization Medical management Referrals +15

Entry Full Time

USD 45K+

Manager, Quality Assurance
Remote-AR, United States

Centene Corporation

Inter-departmental Collaboration KPI metrics Guidelines Customer Care Quality Standards Supervisory Procedures Training Development Performance Management +18

USD 85K+

Contract Negotiator III
Remote-CA, United States

Centene Corporation

Guidelines Provider experience Contract Analysis Claims Adjudication Contract Compliance Adjudication Provider Relations Healthcare administration Health Plan +20

Senior Mid Full Time

USD 68K+

Escalation Response Specialist II
Remote-FL, United States

Centene Corporation

Medicare Guidelines Guidelines Provider experience Escalation management Claims payment Contact center Tracking Customer Care Healthcare Knowledge +19

Entry Mid Full Time

USD 34K+

Care Management Support Coordinator II
Remote-OK, United States

Centene Corporation

Guidelines Social determinants Social Determinants of Health Health Plan Customer Care Referrals Community Resources Procedures Care management +17

Entry Mid Full Time

USD 34K+

Senior Marketplace Member Liaison HICS
Remote-AR, United States

Centene Corporation

Case work Aca Guidelines Quality review Commercial Insurance Marketplace CMS Procedures Managed Care +16

Senior Mid Full Time

USD 52K+

Workforce Real-Time Management Analyst I
Remote-NY, United States

Centene Corporation

Contact Center Management Real-time Analytics Guidelines Workforce management Contact center Customer Care Resource Allocation Scheduling Health Insurance +13

Entry Mid Full Time

USD 44K+

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

Centene Corporation

Guidelines Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Utilization Review +21

USD 52K+

Care Coordinator
Remote-FL, United States

Centene Corporation

Education on Benefits Guidelines Service assessments Member Outreach Home visits Care Coordination Referrals Care management Regulatory requirements +15

Entry Mid Full Time

USD 55K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

ABA services Autism spectrum disorder Guidelines Medical appropriateness Behavioral Analysis Healthcare Provider Interaction Clinical Standards Applied Behavior Analysis Treatment plans +29

USD 95K+

Authorization Specialist II
Remote-MO, United States

Centene Corporation

Healthcare eligibility Authorization processes Guidelines Authorization requests Insurance coverage Researching Adjudication Insurance Knowledge Utilization +19

Entry Mid Full Time

USD 55K+

Contract Negotiator I
Remote-MO, United States

Centene Corporation

Guidelines Provider experience Contract Analysis Contract Compliance Claims Adjudication Adjudication Provider Relations Healthcare administration Health Plan +20

Entry Mid Full Time

USD 55K+

Contract Negotiator I
Remote-IA, United States

Centene Corporation

Healthcare Programs Guidelines Provider experience Contract Analysis Contract Compliance Claims Adjudication Adjudication Provider Relations Healthcare administration +20

Entry Mid Full Time

USD 55K+

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Remote Jobs with GBP > 80K in Salary Remote Jobs with CAD > 80K in Salary Remote Jobs with GBP > 100K in Salary Remote Jobs with CAD > 100K in Salary Remote Jobs with EUR > 80K in Salary Remote Jobs with PHP > 40K in Salary Remote Jobs with PHP > 80K in Salary Remote Jobs with PHP > 60K in Salary Remote Jobs with CAD > 120K in Salary Remote Jobs with PHP > 220K in Salary Remote Jobs with PHP > 200K in Salary Remote Jobs with PHP > 240K in Salary Remote Jobs with PHP > 180K in Salary Remote Jobs with PHP > 260K in Salary Remote Jobs with PHP > 160K in Salary Remote Jobs with PHP > 120K in Salary Remote Jobs with PHP > 100K in Salary Remote Jobs with GBP > 120K in Salary Remote Jobs with PHP > 140K in Salary Remote Jobs with PHP > 300K in Salary