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Health Plan Remote Jobs

56 fresh jobs found

Member Relationship Liaison
Remote-MO, United States

Centene Corporation

Telephonic Education Provider outreach Provider experience Client satisfaction Health Plan CMS Medical management Health Services Problem Resolution +18

USD 55K+

Director, Auditing, Monitoring & Oversight (Marketplace)
Remote-MO, United States

Centene Corporation

Oversight tools Executive Reporting Audit readiness Government programs Health administration Compliance requirements Healthcare Regulations Compliance management Health Plan +37

Exec Senior Full Time

USD 116K+

Manager, Provider Relations
Remote-OK, United States

Centene Corporation

Health delivery systems Provider contracts Provider Contracting Staff management Provider Relations Health Plan Credentialing Quality Standards Supervisory +16

USD 86K+

Provider Engagement Account Manager
Remote-OK, United States

Centene Corporation

Cost and utilization Network performance Quality measures Utilization Provider education Provider engagement HEDIS Provider Relations Health Plan +28

USD 55K+

Provider Engagement Administrator II
Remote-NJ, United States

Centene Corporation

Claims reimbursement Claims billing Cost and utilization Network performance Utilization Provider education Provider engagement HEDIS Provider Relations +27

USD 55K+

Provider Account Manager II
Remote-TX, United States

Centene Corporation

Health Plan Operations Provider Contracting Data Systems Long Term Care Commercial Insurance Provider Relations Health Plan Performance Improvement Issue Resolution +27

USD 55K+

Care Manager - Atlantic and/or Ocean County
Remote-NJ, United States

Centene Corporation

Substance Use Disorders Treatment options Complex Care Management Home visits Healthcare Education Substance use Digital Outreach Personalized care plans Substance Use Disorder +30

USD 55K+

Care Management Support Coordinator II
Remote-OK, United States

Centene Corporation

Record keeping Customer Care Health Plan Social Determinants of Health Referrals Community Resources Problem Resolution Procedures Regulatory requirements +17

Entry Mid Full Time

USD 55K+

Lead Grievance & Appeals Coordinator
Remote-CA, United States

Centene Corporation

Grievance Management Appeals processing Grievance Ncqa standards NCQA Compliance monitoring Report Preparation Health Plan Appeals +21

Senior Mid Full Time

USD 44K+

Provider Engagement Account Executive
Remote-OK, United States

Centene Corporation

Value-based performance Utilization Cost and utilization Interpersonal relationships Quality measures HEDIS Health administration Provider engagement Network management +37

Exec Mid Full Time

USD 86K+

Manager, HEDIS Operations (Non-Clinical)
Columbus (OH) - 4349 Easton Way, Ste 200 (10012) (BHP), United States

Centene Corporation

CAHPS Quality audits Clinical Quality Quality Metrics HEDIS Healthcare Management Health Plan Community Health Stakeholder Collaboration +23

USD 86K+

Quality Program Strategist II
Remote-IA, United States

Centene Corporation

HOS CAHPS Quality performance Cphq HEDIS Health Plan Clinical Experience Cross-functional Teams Strategic initiatives +28

USD 68K+

Principal Fraud & Abuse Investigator
Sentara Health Plans Florida- Remote, United States

Legal support Healthcare Compliance Health Plan Microsoft Access Verification Fraud Investigation Claims processing Pharmacy Auditing +16

Senior Full Time

USD 72K+

Remote TEAM COORD, SIU
Virginia Premier Health Plan Richmond, United States

Healthcare Fraud Speaking Service orientation Active learning Medical Review Healthcare Compliance Health Plan Verification Judgment +29

Senior Mid Full Time

USD 76K+

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+

Contract Implementation Analyst
Remote-LA, United States

Centene Corporation

Provider information system Provider contracts Contract implementation Amisys Claims payment Government programs UAT testing Claims analysis Contract Analysis +21

Entry Mid Full Time

USD 44K+

Remote PRN Medical Director - Missouri
Remote-MO, United States

Centene Corporation

Clinical quality improvement Pediatrics Health financing Clinical programs Personnel management Clinical Quality Medical Review Health administration Medical Services +24

Exec Mid Part Time

USD 212K+

Director, Government Affairs
Remote-OK, United States

Centene Corporation

Legislative analysis Lobbying Health administration Government relations Health Plan Financial Performance Public Policy Regulatory Health Insurance +9

Exec Mid Full Time

USD 132K+

Maternity Clinical Practice Advisor
Remote-NV, United States

Centene Corporation

Maternal care Utilization metrics Clinical Practice Guidelines RN licensure Community partnerships Clinical Initiatives Quality performance Billing practices Clinical Standards +43

USD 68K+

Senior Manager, Healthcare Analytics
Remote-MO, United States

Centene Corporation

Table creation QRS Data design Quality measures Stored Procedures Query optimization Data verification NCQA Microsoft Power BI +64

Senior Full Time

USD 105K+

Provider Engagement Account Manager (BH Exp)
Remote-MS, United States

Centene Corporation

Cost and utilization Network performance Quality measures Provider education Provider engagement HEDIS Health Plan Provider Relations Issue Resolution +26

USD 55K+

Senior Actuarial Analyst - Marketplace / ACA
Remote-MO, United States

Centene Corporation

Health insurance products R-Studio Actuarial Analysis Pricing strategies Health Plan Actuarial Marketplace Effective Communication Pricing +21

Senior Full Time

USD 68K+

Quality Program Strategist
Remote-OH, United States

Centene Corporation

Health program design Cphq Quality Initiatives Quality Metrics Program Design Health Plan Lean Six Sigma Methodologies Risk assessments +18

USD 55K+

Community Resource Coordinator II
Miami-9552 SW 160 St (10961), United States

Centene Corporation

In-person outreach Non-clinical assessments Member support Community education Health Assessments Health education Community outreach Health Plan Telephonic Outreach +15

Entry Mid Full Time

USD 55K+

Non-Emergent Medical Transportation Manager
Remote-IN, United States

Centene Corporation

Transportation strategy Health administration Health Plan Medical Services Audits Network Auditing Nursing Medicare +14

USD 68K+

Community Resource Coordinator II
Remote-FL, United States

Centene Corporation

In-person outreach Non-clinical assessments Member support Community education Health Assessments Health Plan Health education Community outreach Telephonic Outreach +14

Entry Mid Full Time

USD 55K+

Community Resource Coordinator II
Remote-MO, United States

Centene Corporation

Non-clinical assessments In-person outreach Member support Community education Health Assessments Home visits Health Plan Health education Community outreach +15

Entry Mid Full Time

USD 55K+

Contracts Manager
Remote-AR, United States

Centene Corporation

Cost and utilization Contract Development Provider Contracting Operational performance Healthcare Delivery Health Plan Provider Relations Healthcare administration Procedures +18

USD 86K+

Quality Practice Advisor
Remote-IL, United States

Centene Corporation

Clinical Relationship Management Cphq Documentation standards Risk Adjustment Coding Medical record documentation NCQA Provider education Health Plan HEDIS +23

USD 52K+

Health Care Analyst
Remote-NY, United States

Centene Corporation

Quality review Claims analysis Health Plan Regulatory reporting Information systems Claims Database Management Mathematics Databases +23

Entry Mid Full Time

USD 55K+

Vice President, Network Strategy & Management
Remote-MO, United States

Centene Corporation

Unit cost management M&A activities Provider network management Claims Configuration Network strategy Contracting Strategy Reimbursement strategy Contract Analysis Government programs +33

USD 231K+

Provider Account Manager
Remote-TX, United States

Centene Corporation

Claims billing practices Claims billing Billing practices Health Plan Commercial Insurance Provider Relations Client Services Contracting Service Delivery +23

USD 55K+

Pharmacy Coordinator II
Remote-NV, United States

Centene Corporation

Formulary process Prior authorizations Grievances Managed care experience Health Plan Provider Relations Utilization Review Prior authorization Medical management +18

USD 77K+

Pharmacy FWA Investigator I
Remote-FL, United States

Centene Corporation

Pharmacy fraud Waste and abuse Audit experience Retail Pharmacy Corrective action plans Government programs Claims analysis Pharmacy Technician Health Plan +31

Entry Mid Full Time

USD 44K+

Supervisor, Regulatory Operations
Remote-IL, United States

Centene Corporation

Health insurance regulations SERFF Hios Legislation Analysis Issue advocacy Policy Research System enhancements Regulatory research Regulatory Interpretation +29

USD 86K+

Education Coordinator I
Remote-GA, United States

Centene Corporation

Member management software Learning Technologies Education and Training Health Plan Adult Learning Principles Methodologies Training Programs Clinical operations Instructional Design +15

USD 55K+

Remote Medical Director (PRN) - California
Remote-CA, United States

Centene Corporation

Clinical quality improvement Clinical programs Health financing Medical Review Clinical Quality Personnel management Health Plan Health administration Medical Services +24

Exec Mid Part Time

USD 222K+

Adoption Consultant
Remote-MO, United States

Centene Corporation

Health plan relationships E-business tools Adoption strategies Provider workflow Provider experience Outbound Calling Health Plan Logging Strategic initiatives +19

USD 86K+

Manager, Process Operations
Remote-MO, United States

Centene Corporation

Health care operations Claims Administration Health Plan System Administration Medical management Claims processing Health Services Procedures Supervisory +24

USD 86K+

Manager, Network Strategy and Market Analysis
Remote-FL, United States

Centene Corporation

Performance Insights Network strategy Provider network development Health Plan Health administration Strategic initiatives Data-driven decision making Risk mitigation Network +30

USD 86K+

Provider Data Coordinator II
Remote-NY, United States

Centene Corporation

Provider data issues Provider data management Health Plan Microsoft Access Reconciliation Claims Network Databases Managed Care +15

USD 44K+

Staff Vice President UM Special Markets - FL
Remote-FL, United States

Centene Corporation

UM Healthcare Delivery Health Plan Clinical Guidelines Strategic Leadership Medical management Cross-functional Teams Procedures Data-driven decision making +28

Senior Full Time

USD 182K+

Care Management Support Coordinator II
Remote-NY, United States

Centene Corporation

Health Plan Record keeping Customer Care Social Determinants of Health Referrals Community Resources Procedures Problem Resolution Care management +16

Entry Mid Full Time

USD 55K+

Sr Financial Analyst
Working Virtually, United States

MultiCare Health System

Decision support systems Decision support System Support Health Plan Database Administration Accuracy Microsoft Outlook Business Intelligence Health care +19

Senior Mid Full Time

USD 69K+

Medical Management Auditor
Remote-WI, United States

Centene Corporation

CCMS Clinical Systems InterQual System Maintenance Corrective Actions Health Plan Credentialing Appeals Medical management +16

USD 55K+

Senior Director, Compliance Advisory (Marketplace)
Remote-MO, United States

Centene Corporation

ACA requirements Executive Reporting Audit readiness Government programs Health Plan Compliance requirements Metrics Development Health administration Healthcare Regulations +36

Senior Full Time

USD 145K+

Risk Adjustment Specialist II - (non-clinical)
Remote-AZ, United States

Centene Corporation

ICD10 coding Claims knowledge Risk Adjustment Coding Medical record documentation Health Plan Provider education Health administration Risk Adjustment Methodologies +25

USD 95K+

Supervisor, Appeals Grievance
Remote-MO, United States

Centene Corporation

Appeals Management Grievance resolution Grievances Health Plan Report Preparation Performance Evaluation Trend Analysis Appeals Medical management +23

USD 55K+

Manager, Clinical Pharmacy (Prior Authorization)- Remote!
Sentara Health Plans Virginia Beach II, United States

Electronic prior authorization Outcomes assessment Health Plan Management Service orientation Formulary management Speaking Active learning Health Plan Staff management +25

Senior Mid Full Time

USD 42K+

Care Manager
Remote-IL, United States

Centene Corporation

Member education Care Plan Development Complex Care Management Substance Use Disorders Compliance Documentation Treatment options Substance use Health Plan Home visits +31

USD 55K+

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