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InterQual Remote Jobs

20 fresh jobs found

Appeals and Grievances Clinical Specialist – RN, LPN, or Dental Hygienist - 100% Remote
Remote - NY, United States

Clinical Case Development Macess Dental Hygienist Hyland Medicare Guidelines Care Management Systems TruCare Case Resolution CCMS +18

USD 71K+

UM Case Manager - 100% Remote
Remote - NY, United States

NYSDOH regulations PT ST OT Notifications CMS regulations Milliman LMSW LMHC +25

USD 71K+

Case Manager- Out of Network Management- System Services- Remote -Full Time- Days
System Services-Telecommuter, United States

Sharp HealthCare

Health plan criteria MCG Clinical Nursing Healthcare Coordination InterQual Patient Assessment Utilization Review Utilization management Consultation +6

USD 60K+

Sr. Nurse Reviewer - Provider Relations
Any city, MA, US, 99999

Gainwell Technologies

Interqual criteria Prepayment review Pre-admission screening Post payment review RN license InterQual Processes Provider Relations Clinical Review +30

Senior 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+

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+

Utilization Review Author (Weekend)
Remote, GA, United States

Milliman Evidence-based criteria Case reviews Management experience InterQual Data Abstraction Basic Computer Intelligent Automation Utilization Review +16

USD 78K+

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+

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+

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+

Medical Director - Southeast Region
Remote US, United States

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

Exec Senior Full Time

USD 223K+

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+

Medical Director - South Central
Remote US, United States

Community Groups Grievance and appeals processes Outpatient services Post-acute services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Social determinants +85

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Clinical guidelines knowledge Managed Care Knowledge Medicare Knowledge Commercial health insurance Clinical group practice management Inpatient rehabilitation Clinical Decision Making Social determinants Grievance and appeals +78

Exec Senior Full Time

USD 223K+

Utilization Review Author
Remote, GA, United States

Case reviews Management experience Evidence-based criteria Milliman Data Abstraction InterQual Basic Computer Intelligent Automation Workflow Orchestration +15

USD 78K+

Medical Director- South Central
Remote US, United States

Post-acute services Clinical group practice management Commercial health insurance Outpatient services Grievance and appeals processes Clinical Decision Making Post-acute care Inpatient rehabilitation Social determinants +83

Exec Senior Full Time

USD 223K+

Medical Director (Clinical Chart Validation Team)
Remote, United States

Decision support software Chart validation Provider Billing Milliman DRG ICD-9 Coding accuracy MCG InterQual +32

Exec Senior Full Time

USD 190K+

Medical Director - Southeast Region
Remote US, United States

Post-acute services Outpatient services Grievance and appeals processes Clinical group practice management Inpatient rehabilitation Commercial health insurance Coding practices Medical background Hospitalist +82

Exec Senior Full Time

USD 223K+

Pediatric Care Manager
Remote - NY, United States

Pediatric care management Multilingual (Spanish Community health practices Locadtr Health care coordination Electronic Documentation Pediatric care Cantonese Korean +7

USD 71K+

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