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Managed Care Remote Jobs

357 fresh jobs found

VBC Operations Accounting Specialist III (Remote based in US)
United States

Tenet Healthcare

Capitation revenue Office Software Financial controls Account Reconciliation Healthcare industry expertise Journal entries General Ledger Financial statements Accounting Principles +17

Senior Mid Full Time

USD 66K+

Field Access Manager, Midwest
Chicago, IL, United States · Minneapolis, MN, United States

Blueprint Medicines

CRM Database Management Payer policies Authorization processes Pharmaceutical Knowledge Biotech experience Patient Support Programs Healthcare Education Product Launch Hematology +18

Senior Mid Full Time

USD 185K+

Business Analyst III - Medical Coding
Remote-MO, United States

Centene Corporation

Claims Coding Analysis Amisys Claims Payment System Amisys Implementation processes Process redesign Business Objects Claims payment Operational performance Business Process Analysis +29

Senior Mid Full Time

USD 68K+

Financial Data Analyst II
Remote-NY, United States

Centene Corporation

Facets system Process redesign Facets Financial Forecasting Health Plan Process documentation User Acceptance Testing Financial Statistical analysis +20

USD 55K+

Prevention Health Specialist - Must reside in Mississippi
Mississippi WFH, United States

Preventive Health Services Proper grammar usage Phone Etiquette Provider engagement Healthcare Regulations Critical Listening Community Health Customer Care Population health +24

USD 48K+

Lead, HCS BH Access RN, BHSW or LCSW Remote with field travel in the NY, CT or NJ
Brooklyn, NY, United States

Molina Healthcare

BHSW Bilingual Chinese Data interpretation LCSW Bilingual (Spanish) RN Managed Care Behavioral health Regulatory Compliance +5

Senior Mid Full Time

USD 113K+

Operations Analyst
Seattle, Washington, United States

Community Health Plan of Washington

Electronic data interface Stakeholder consultation Encounter data reporting Benefits configuration Data assessment Health Plan Operations Claims coding Claims Adjudication Quality improvement +7

Entry Mid Full Time

USD 71K+

Cultural Competency Coordinator
REMOTE OPTIONS, PHOENIX

State of Arizona

Translation Services Education Material Development Interpreter Services Ada Cultural Competency Performance measures Equal Opportunity Eligibility verification Eligibility +26

USD 56K+

Supervisor-Government Programs Outreach- Medicare
Albuquerque, NM, United States

Presbyterian Healthcare Services

Data management systems Community outreach Proofreading Customer Education Job aids Project Visio Editing Managed Care +18

Senior Mid Full Time

USD 72K+

Senior Care Manager - Social Worker
Remote-WA, United States

Centene Corporation

URAC Continuum of care Clinical information systems Community services Complex Care Management Provider education Utilization Clinical Information NCQA +24

Senior Mid Full Time

USD 68K+

Utilization Management Coordinator I
Remote-NJ, United States

Centene Corporation

Fraud reporting Performance goals ICD-9 codes Automated Systems Medical Necessity Review Authorization requests Prior authorizations CPT codes ICD-9 +31

Entry Full Time

USD 64K+

Territory Manager, Structural Heart, Structural Interventions – Stroke Prevention (Long Island, Westchester, Bronx NY)
United States of America : Remote

Echo cardiology Cardiac surgery Clinical Orientation Echo Interventional cardiology New Product Development Sales Objectives Structural Heart Demonstrations +36

USD 66K+

Operations Business Analyst III
Dayton WFH, United States

Health care operations Operational Effectiveness Cost-benefit analysis Critical Listening Regulatory reporting Certification Performance Improvement Six Sigma Facilitation +26

Senior Mid Full Time

USD 81K+

Behavioral Health Clinical Liaison
Remote-FL, United States

Centene Corporation

Treatment plan assessment Continuum of care Outpatient Clinical Management Substance use Treatment plans Provider education Utilization Clinical Information +33

Senior Mid Full Time

USD 68K+

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

Centene Corporation

Medicaid Assessments Quality care Rehab ICU Continuum of care Service authorization Service coordination Long Term Care Healthcare Education +39

Senior Full Time

USD 70K+

Senior Care Manager (RN)
Remote-FL, United States

Centene Corporation

Quality care Community resource collaboration Service coordination Spanish Speaking Complex Care Management Healthcare Coordination Healthcare outcomes Service plans Telephonic Outreach +29

Senior Mid Full Time

USD 73K+

Pharmacy Operations Specialist I
Remote-CA, United States

Centene Corporation

Quality process improvement Training material creation Pharmacy operations Pharmacy Technician UAT Medical management Health Services Pharmacy Managed Care +16

USD 47K+

Account Manager - Hematology (Portland)
Remote (US), United States

Strategic focus Hospital markets Iv medications Orals Injectables Specialty sales Managed markets Medicare part d Patient Support Programs +39

Senior Mid Full Time

USD 153K+

Diabetes Sales Associate -- Chicago South, IL
United States of America : Remote

Glucose Monitoring Nutrition Products Informatics systems Quality System Heart failure Interventional Pain Therapy Implantable devices Medical technologies Diabetes Care +37

USD 60K+

Technical Business Analyst
Remote - NY, United States

Macess Visual Basic Pega Qlikview Cognos VBA Reporting tools Kanban Technical Design +21

Entry Mid Full Time

USD 67K+

Quality Assurance Investigative Nurse (District East Nurse)
REMOTE OPTIONS, CHANDLER

State of Arizona

Clinical Health Investigative Nursing Investigative Documentation Incident reporting Review Quality of care Regulatory reporting Performance measures Equal Opportunity +40

USD 66K+

Pre-Certification Coordinator - Department of Medicine - Business Office
Remote - Missouri, United States

Washington University in St. Louis

Internal customers Medical insurance coding Third party payers External customers Pre-certification Health Information Management Office Equipment Organizing Screening +12

Entry Mid Full Time

USD 61K+

Senior Director, Market Chief Financial Officer
Michigan WFH, United States

Health analytics Strategic support Accounting Concepts Budget Forecasting Financial Oversight Problem identification Reimbursement methodologies Critical Listening Risk Adjustment +24

Senior Full Time

USD 132K+

Senior Data Manager
Remote US, United States

VB ADF Azure Synapse Analytics MS Azure Synapse Visualizations Azure Synapse Problem Analysis Qlikview +80

Senior Full Time

USD 97K+

Enrollment Analyst II (SQL required)
Dayton WFH, United States

Cognizant Facets Provider network Provider data management Provider Recruitment Facets NCQA Microsoft Access Certification Performance Improvement +25

USD 61K+

Credentialing Specialist II
Seattle-600 University St., Ste. 400 (10345), United States

Centene Corporation

Provider data management Ncqa standards NCQA Credentialing Data processing Managed Care Health Insurance Data Management Flexibility +9

USD 77K+

Implementation Pharmacist
Dayton WFH, United States

Clinical implementation Healthcare data interpretation Clinical configuration Medical drug management Formulary Development Claims oversight Process Mapping Certification Clinical expertise +22

USD 92K+

Vice President, Population Health - Care Management
Remote-MO, United States

Centene Corporation

Consumer assessment URAC CAHPS Member engagement HEDIS NCQA Health Plan Population health Medical management +28

USD 182K+

Medical Director - Southeast Region
Remote US, United States

Computer-Based Review Health claims review Post-acute services Grievance and appeals processes Outpatient services Inpatient rehabilitation Post-acute care Clinical group practice management Commercial health insurance +87

Exec Senior Full Time

USD 223K+

Business Analyst II Benefits Implementation
Remote-MO, United States

Centene Corporation

Managed Care Information Systems Provider reimbursement methodologies Structured Testing Claims Configuration Implementation processes Managed Care Information Operational reporting Claims payment Reimbursement methodologies +36

USD 55K+

Business Analyst III - Configurations Testing
Remote-MO, United States

Centene Corporation

Claims Configurations Testing Structured Testing Provider reimbursement methodologies Implementation processes Managed Care Information Quality Auditing Process redesign Medical claims Claims payment +32

Senior Mid Full Time

USD 68K+

Director, Product Marketing & Member Communications
Remote-MO, United States

Centene Corporation

Publishing software Community Development Health Plan Journalism Communication Strategies Public Relations Branding Public speaking Managed Care +14

Exec Senior Full Time

USD 116K+

UM Coordinator 2
Remote US, United States

Clinical information review Computations ICD-10 codes Process Flows ICD Microsoft Office Applications Medical necessity Utilization Review Prior authorization +52

Entry Mid Full Time

USD 40K+

UM Coordinator 2 (Bilingual)
Remote US, United States

Process Navigation Computations ICD-10 codes Process Flows ICD Microsoft Office Applications Medical necessity Utilization Review Prior authorization +51

Entry Full Time

USD 40K+

Utilization Management Nurse 2-Remote, US
Work at Home - Kentucky, United States

Technical Savvy CGX Health Plan Experience Home Health Mobile Productivity Consumer Experiences Data interpretation Value-based care +50

USD 71K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Peer-to-peer discussions Clinical Decision Making Evidence-Based Guidelines Software tools Gastroenterology Clinical Intelligence Patient outcomes +18

Senior Mid Full Time

USD 200K+

Associate Director, Ohio Medicaid Strategy & Financing (Project management & Policy guidance) - Remote
Remote

Medicaid financing Policy guidance Medicaid policy Policy Research Client Consulting Healthcare policy Consulting Services Healthcare Consulting Public Policy +17

Senior Mid Full Time

USD 116K+

Quality Program Strategist II
Remote-FL, United States

Centene Corporation

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

USD 68K+

LTSS Service Care Manager
Remote-TX, United States

Centene Corporation

Large databases Psychosocial services Holistic care Resiliency Health Assessments Home visits Quality of care Medical Services Resource support +38

USD 95K+

Account Manager - Hematology (Boston, MA)
Remote (US), United States

Orals Iv medications Hospital markets Strategic focus Injectables Specialty sales Managed markets Medicare part d Patient Support Programs +40

Senior Mid Full Time

USD 153K+

Account Manager - Hematology (Atlanta South)
Remote (US), United States

Orals Hospital markets Strategic focus Iv medications Injectables Specialty sales Managed markets Medicare part d Patient Support Programs +38

Senior Mid Full Time

USD 153K+

Account Manager - Hematology (Pittsburgh, PA)
Remote (US), United States

Hospital markets Orals Iv medications Strategic focus Injectables Specialty sales Managed markets Medicare part d Patient Support Programs +39

Senior Mid Full Time

USD 153K+

Provider Engagement Network Specialist
Remote-CA, United States

Centene Corporation

Network reporting Demographic information changes Provider directories Provider information system Contract research Medical claims Claims payment Provider engagement Provider education +24

USD 44K+

Provider Data Coordinator II
Remote-NY, United States

Centene Corporation

Provider data management Health Plan Reconciliation Microsoft Access Claims Network Managed Care Databases Health Insurance +14

USD 44K+

Supervisor, Grievance & Appeals
Remote-FL, United States

Centene Corporation

Provider post service appeals Hospital claims Grievance Healthcare law Grievances Appeals Quality Metrics Medical management Health Services +18

USD 55K+

Supervisor, Utilization Management
Remote-OK, United States

Centene Corporation

UM Utilization Accreditation Standards Clinical Review Accreditation Prior authorization Medical management Health Services Utilization management +22

USD 73K+

Provider Network Coordinator I (Must live in Mississippi)
Mississippi WFH, United States

Provider database Provider network Facets Critical Listening Credentialing Certification Contracting Data integrity Network +20

USD 31K+

Health Plan Data Analyst II (Facets Required)
Dayton WFH, United States

Cognizant Facets Provider network Provider Recruitment Facets Provider engagement NCQA Customer Care Microsoft Access Certification +27

USD 61K+

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

Centene Corporation

Continuum of care Service plan development Member advocacy Service authorization Service coordination Utilization Healthcare Coordination Clinical Guidelines Quality of care +33

Senior Full Time

USD 127K+

Account Manager - Hematology (Denver North)
Remote (US), United States

Hospital markets Orals Iv medications Strategic focus Injectables Specialty sales Managed markets Medicare part d Patient Support Programs +39

Senior Mid Full Time

USD 161K+

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