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11 fresh jobs found
Clinical Education Specialist - Remote in US
Any city, FL, US, 99999 Gainwell Technologies logo Gainwell Technologies
Clinical claims review Webinar delivery InterQual criteria DRG validation Medical record auditing Healthcare Policies Coding certification CCS Healthcare policy +39
Senior Full Time
USD 75K+
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Clinical Quality Nurse Reviewer, Sr. Specialist - (RN Remote in US)
Any city, NC, US, 99999 Gainwell Technologies logo Gainwell Technologies
Clinical quality review InterQual criteria Chart Audits Clinical criteria guidelines Productivity standards Medical Record Review RN license InterQual Clinical Criteria +28
Senior Full Time
USD 64K+
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Appeals Review Nurse
Remote Oscar logo Oscar
NCCN Medical decision support tools Level of care reviews Medical necessity reviews Milliman care guidelines Evidence-Based Guidelines InterQual MCG Clinical Guidelines +16
Entry Mid Full Time
USD 70K+
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Medical Director - Northeast Region
Remote US Humana logo Humana
Commercial health insurance Post-acute services Grievance and appeals processes Outpatient services Coding practices Clinical group practice management Judgement Inpatient rehabilitation Hospitalist +80
Exec Senior Full Time
USD 199K+
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REMOTE Utilization Review Nurse - ED - 10 am - 6 pm, 11 am - 7 pm OR 12 pm - 8 pm
GBMC Hospital GBMC HealthCare logo GBMC HealthCare
MCG InterQual Electronic Medical Records Utilization Review Oral communication Critical thinking Written communication Time Management Organizational +3
Mid Full Time
USD 64K+
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Medical Director - National Medicare Team
Remote US Humana logo Humana
Commercial health insurance Project team participation Managed Care Knowledge Clinical Standards Clinical group practice management Humana policies Medical interpretation Medical background National Guidelines +42
Exec Senior Full Time
USD 199K+
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Medical Director- South Central
Remote US Humana logo Humana
Post-acute services Clinical group practice management Clinical Standards Grievance and appeals processes Outpatient services Coding practices Inpatient rehabilitation Medical background Clinical reference materials +78
Exec Senior Full Time
USD 199K+
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Medical Director - Home Health - OneHome/Home Solutions
Remote US Humana logo Humana
Dynamic Environment Interpretative CMS Medicare Clinical Standards Inpatient Care Clinical reference materials Humana policies Medical interpretation CMS policies +44
Exec Senior Full Time
USD 199K+
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Medical Director - Pharmacy Appeals
Remote US Humana logo Humana
Medicare rules Clinical group practice management Humana policies National Guidelines CMS policies Rules InterQual MCG Medical Director +51
Exec Senior Full Time
USD 199K+
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Nurse Reviewer, Appeals and Hearings (Remote)
Any city, KY, US, 99999 Gainwell Technologies logo Gainwell Technologies
Appeals process Clinical criteria guidelines MCG criteria InterQual criteria Medical record coding Cross-training CCS Coding certification InterQual +26
Mid Full Time
USD 64K+
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Medical Director--Claims Management
Remote US Humana logo Humana
Medicare Guidelines Inpatient Care Grievance and appeals processes Coding practices Outpatient services MCG Inpatient rehabilitation National Guidelines Post-acute care +73
Exec Senior Full Time
USD 199K+
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