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Health Services Remote Jobs

162 fresh jobs found

Behavioral Health Service Mgr-BH Medication Monitoring
Remote-OK, United States

Centene Corporation

Behavioral health services Mental health resources Utilization Data Monitoring Clinical Nursing Quality of care Foster care Evidence-based practices Discharge planning +32

USD 95K+

Clinical Pharmacist (MTM Support)
Remote-FL, United States

Centene Corporation

Pharmacy Software Patient Profile Review Multidisciplinary Team Collaboration Drug Therapy Optimization Telephonic Medication Reviews Drug therapy Medication therapy management Clinical pharmacy Medical management +12

USD 105K+

Concierge Specialist
United States - Remote

First Advantage

Drug services Health Services Data Entry Time Management Salesforce Microsoft Office Customer service Organizational Communication

Entry Mid Full Time

USD 30K+

Authorization Specialist I
Remote-NY, United States

Centene Corporation

Authorization processes Healthcare eligibility Utilization Authorization requests Prior authorization Referrals Medical management Health Services Utilization management +13

Entry Full Time

USD 45K+

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+

Quality Improvement Specialist I
Remote-IA, United States

Centene Corporation

Health Services Quality improvement Procedures Coordination Databases Regulatory Audit Health Insurance Data Management +9

USD 44K+

Remote Child / Adolescent Medical Director - Florida
Remote-FL, United States

Centene Corporation

Utilization Claims review Clinical quality improvement Medical management programs Health care quality Provider network development Health financing Personnel management Accreditation Standards +39

Exec Senior Full Time

USD 231K+

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+

Appeals Specialist II
Remote-TX, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Mid Full Time

USD 40K+

Evernorth Implementation Manager - Remote
California Work at Home, United States

The Cigna Group

Vista Tracking systems Client interaction Conflict Management Spreadsheets Clinical operations Detail oriented Health Services Database +39

USD 80K+

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+

Behavioral Health 24/7 Clinical Navigation and Support Care Manager - Evernorth Health Services - Remote
Minnesota Work at Home, United States

The Cigna Group

Confidentiality regulations Telephonic consultation Biopsychosocial assessment Brief therapy Employee assistance programs Solution focused therapy MCG De-escalation Clinical Judgment +32

Senior Mid Full Time

USD 65K+

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+

Grievance & Appeals Coordinator I
Burr Ridge - 1333 Burr Ridge Pkwy, Ste 125 (10938), United States

Centene Corporation

Claims research Utilization Grievance Grievances Managed care experience HEDIS Appeals Medical management Health Services +14

Entry Mid Full Time

USD 64K+

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+

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+

Quality of Care Coordinator
Remote-KS, United States

Centene Corporation

Quality of care assessment Organizational policy adherence Clinical criteria application Clinical Criteria Medical Records Review Cphq Peer review Quality of care Medical Records +18

USD 118K+

Payer Solutions Inpatient UM Case Management Lead Analyst - Evernorth Health Services - Remote
Minnesota Work at Home, United States

The Cigna Group

Chemical dependency Health care services Technology systems Treatment plans Medical necessity Discharge planning Behavioral healthcare Utilization Review Conflict Management +25

Senior Mid Full Time

USD 65K+

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+

Medical Director - Pediatric Pulmonology - EviCore - Remote
Florida Work at Home, United States

The Cigna Group

Evidence-based medical reviews Evidence-Based Decision Making Medical case reviews Automated processes Case Management Software Federal Laws Computer Applications Healthcare Regulations Medical necessity +23

Exec Senior Full Time

USD 203K+

Medical Director- South Central
Remote US, United States

Community Groups Outpatient services Grievance and appeals processes Post-acute services Clinical group practice management Inpatient rehabilitation Post-acute care Commercial health insurance Humana policies +86

Exec Senior Full Time

USD 223K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

Psychologist Reviewer
Remote-SC, United States

Centene Corporation

Education on best practices Diagnostic evaluations Outpatient Psychological testing Peer reviews Substance abuse Clinical Information Clinical Psychology Psychology +18

USD 84K+

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+

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+

Remote Beahvioral Medical Director - Kentucky
Remote-KY, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Health care quality Medical management programs Health financing Provider network development Government programs Clinical Quality Medical Review +39

Exec Mid Full Time

USD 231K+

Senior Pharmacy Resolution Specialist
Remote-MI, United States

Centene Corporation

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

Senior Mid Full Time

USD 64K+

Humana Healthcare Research Spring 2025 Internship
Remote US, United States

Quantitative healthcare research Statistical coding languages Manuscript authorship Causal inference methods Pharmacoepidemiology Time Series Health Services Research Real-world data analysis Time Series Analysis +41

Entry Internship Part Time

USD 37K+

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+

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+

Resource Planning Senior Analyst - Evernorth - Remote
Illinois Work at Home, United States

The Cigna Group

Call center analysis Workforce management Workforce Planning Resource Planning Capacity planning Resource Allocation Health Services Verbal and written communication Consultative +15

Senior Mid Full Time

USD 51K+

Clinical Programs Pharmacy Technician Representative 2
Remote US, United States

Call center processes Medication therapy Insurance processing Bilingual English and Spanish Prescription Clinical programs Medication Adherence Development programs Home health services +37

USD 40K+

Clinical Program Senior Advisor - Express Scripts - Remote (Wholesale Market)
Missouri Work at Home, United States

The Cigna Group

Digital health innovations Healthcare delivery models Formulary management Clinical Strategy Microsoft Applications Analytic Financial Health Services Consultative +24

Senior Full Time

USD 116K+

Senior Manager, Claims Configuration Operations
Remote-MO, United States

Centene Corporation

Claims Configuration Quality Standards Medical management Health Services Quality improvement Claims Business administration Business strategy Managed Care +21

Senior Full Time

USD 105K+

Rx Clinical Programs Pharmacy Technician Representative 2
Remote US, United States

Financial assistance resources Medication assistance Bilingual English and Spanish Computations Prescription Clinical programs Medication Adherence Development programs Home health services +31

Entry Mid Full Time

USD 40K+

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+

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+

Grievance & Appeals Coordinator II
Remote-PA, United States

Centene Corporation

Grievance Grievance resolution Grievances Claims analysis Medical Review Appeals Medical management Health Services Procedures +17

USD 44K+

Opioid Case Management Lead Analyst - Evernorth Health Services - Remote
Ohio Work at Home, United States

The Cigna Group

Pain management Cognitive behavioral coaching Telephonic counseling Telephonic support Health care services Treatment plans Health education Substance Use Disorder Goal setting +29

Senior Mid Full Time

USD 65K+

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+

Senior Clinical Programs Pharmacist
Remote US, United States

Medication therapy Benefits management Prescription Medication Adherence Clinical programs Development programs Home health services Microsoft Office Applications Home Health +57

Senior Full Time

USD 104K+

Medication Therapy Management Clinical Pharmacist
Remote-FL, United States

Centene Corporation

Patient profile evaluation Software management Telephonic Medication Reviews Drug Therapy Optimization Drug therapy Multidisciplinary teamwork Medication therapy management Clinical pharmacy Medical management +12

USD 105K+

Medical Policy Analyst
Remote-MO, United States

Centene Corporation

Medical literature research Health care management Technology assessments Clinical Practice Guidelines Evidence-based medicine Medical policy Acute care Medical management Health Services +14

Entry Mid Full Time

USD 68K+

Claims Systems Senior Analyst - eviCore - Remote
Tennessee Work at Home, United States

The Cigna Group

MPPR OPPS FFS MC400 MCNET Configuration design RC3 HCPC RBRVS +32

Senior Full Time

USD 53K+

Authorization Specialist I
Remote-MO, United States

Centene Corporation

Authorization processes Healthcare eligibility Authorization requests Prior authorization Medical management Referrals Health Services Procedures Utilization management +12

Entry Full Time

USD 45K+

Appeals Specialist II
Remote-NY, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Full Time

USD 40K+

Senior Informaticist - CMS Stars
Remote US, United States

STARS Modeling techniques Medication Adherence Qlikview Development programs Home health services Articulate Home Health Simulation +54

Senior Full Time

USD 97K+

Manager, Clinical Pharmacy Operations (Medicare Part D)
Remote-TX, United States

Centene Corporation

Pharmacy Claims Analysis Formularies Formulary management Medicare part d Operations support Pharmacy operations WebEx Clinical pharmacy Performance Evaluation +27

USD 105K+

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+

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+

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