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Managed Care Remote Jobs

240 fresh jobs found

Director, Network Contracting & Services
Remote

Provider management Healthcare Strategy Contracting Strategies Network performance Quality care Provider Contracting Network development Cost Containment Healthcare Delivery +25

Exec Senior Full Time

USD 142K+

Senior Director, Network Contracting & Services
Remote

Network Contracting Contracting Strategies Healthcare Strategy Quality care Network performance Provider Contracting Network development Provider Relations Cost Containment +28

Senior Full Time

USD 192K+

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

Washington University in St. Louis

Medical insurance coding Internal customers Third party payers External customers Pre-certification Health Information Management Organizing Office Equipment Interpersonal Communication +11

Entry Mid Full Time

USD 61K+

Lead Director, Pharma Contracting
Downers Grove-3200 Highland Av, United States

Formulary Strategies Rebate Contracts Specialty Pharmacy Pharmaceuticals Pharmacy Contract Negotiation Market Access Managed Care Health care +14

Senior Full Time

USD 100K+

Senior Data Manager
Remote US, United States

Azure Synapse Analytics ADF Synapse Azure Synapse Data Models Qlikview SPSS SSIS Azure Data Factory +75

Senior Full Time

USD 97K+

Virology Customer Representative - Albany & Syracuse, NY
USA - Pennsylvania - North Wales (Upper Gwynedd), United States

Ethics and Compliance Virology Products Virology Customer Strategy Health outcomes IDS Payer Environment Technology Utilization Customer segmentation +46

Senior Mid Full Time

USD 101K+

Lead Pre Certification Coordinator (Remote) - Business Office - Medicine
Remote - Missouri, United States

Washington University in St. Louis

Organizational savvy Fast-paced environments External customers Insurance terminology Pre-certification Medical billing and coding Health Information Management Office Equipment Medical Billing +17

Senior Mid Full Time

USD 44K+

Social Worker Care Coach - Eau Claire
Eau Claire, United States

Preventive education Care Plan Development Community Resource Coordination Driver safety program Travel Coordination Community integration Social service care management Health and wellness Family Care +39

USD 53K+

Utilization Review Nurse
Remote

Care engagement Level of care reviews Milliman care guidelines Medical necessity reviews Evidence-Based Guidelines Clinical Guidelines Clinical Review RN licensure Technology Platform +13

USD 70K+

Tele-Triage LPN - SNF
LOUISVILLE, KY, United States

BrightSpring Health Services

Medication coordination Tele-triage Nursing care plans Care Plans Triage LPN Clinical Documentation Patient Assessment Care Coordination +13

USD 40K+

Medical Coding Specialist II/CPC/CCS- Remote!
SMG Central Billing Office Military Hwy, United States

Insurance adjudication Gecb Allscripts Statements Billing cycle Contractual agreement Payment posting Charge Entry Health Plan +17

Senior Mid Full Time

USD 62K+

31091817 Government Account manager -- Northeast
United States of America : Remote

Quality System Implementation Glucose Monitoring Nutrition Products Informatics systems Molecular diagnostics Interventional Pain Therapy Implantable devices Mobile technology Cardiac Rhythm Technologies +53

USD 83K+

Business Intelligence Lead
Remote US, United States

Claims Administration Analytics Solutions Functional strategies Qlik Analyzing Visualizations Microsoft Office Applications Budget development Trend Analysis +69

Senior Full Time

USD 117K+

Telephonic Behavior Health Care Manager
Remote US, United States

Community health navigation Interagency collaboration Social service agencies Case coordination Pediatric care Community Health Community Resources Psychology Consumer Experiences +35

USD 59K+

Clinical Supervisor
Remote

UM guidelines Milliman care guidelines Navigation Clinical Leadership Technology Platform LCSW Social Work Operations Management Health Insurance +26

USD 88K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Evidence-Based Guidelines Peer-to-peer discussions Software tools Clinical Review Medical necessity Clinical Intelligence Clinical Acumen Utilization Review +12

Senior Mid Full Time

USD 200K+

Case Manager - Sparta, WI
Sparta, United States

Face-to-face assessments Employment support Driver safety program Housing support Community Resource Coordination Health and Wellness Coordination Community integration Social service care management Prevention +40

USD 53K+

Senior Pharmacy Technician - Call Center - Work From Home Oklahoma
Work At Home-Oklahoma, United States

Computer navigation Pharmacy Technician Phone Prior authorization Software Applications Retail Medical terminology Pharmacy Call Center +19

Senior Full Time

USD 36K+

Case Manager- Weston
Work at Home - Wisconsin, United States

Driver safety program Health and Wellness Coordination Community integration Social service care management Social services Prevention Family Care Health and wellness Human services +39

USD 53K+

Contract Manager
Recruiting Only - Telecommuter, United States

Action plans Motivational Interpretive Performance competencies PC literate Microsoft Office products Supervisory Disability Judgment +20

USD 45K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Evidence-Based Guidelines Peer-to-peer discussions Clinical Decision Making Software tools Clinical Review Medical necessity Clinical Intelligence +12

Senior Mid Full Time

USD 200K+

Health Program Manager 2
REMOTE OPTIONS, PHOENIX

State of Arizona

Operational reviews Review Program Planning Google Applications Policy interpretation Eligibility verification Equal Opportunity Community Resources Federal regulations +39

USD 58K+

Healthcare Call Center Supervisor (Hybrid Onsite in Orange, CA and Work-From-Home)
Orange, California, United States

Alignment Health

Team Motivation Performance coaching Medicare Managed Care Call Center Management Medicare Advantage Supervisory Training and Development Data integrity Call Center +14

USD 57K+

Associate Director, Market Access Early Pipeline & BD&L - Remote
Remote Position (USA), United States

Payer coverage Reimbursement strategy Pipeline Strategy Access and Reimbursement Health policy Commercial Strategy Clinical Trial Design Health Economics Market strategy +33

USD 174K+

Population Health Quality Data Analyst
Working Virtually, United States

MultiCare Health System

Healthcare quality metrics Quality measure performance reporting Utilization data Health care metrics Financial Data Medical claims Operational Managed Care Health care +10

Entry Mid Full Time

USD 57K+

Territory Manager, Structural Heart - Stroke Prevention- Tampa Florida
United States of America : Remote

Echo cardiology New Product Development Clinical Orientation Cardiac surgery Echo Interventional cardiology Healthcare Solutions Sales Growth Structural Heart +36

USD 72K+

Senior Product Manager, TEPEZZA- Rare Disease (Remote)
Deerfield (Horizon), United States

Speaker Training Strategic Marketing Endocrinology Brand Strategy Regulatory Guidelines Brand Management Pharmaceuticals Rare Disease Messaging +26

Senior Full Time

USD 152K+

Medical Director - Florida
Remote US

Home health services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Inpatient rehabilitation Post-acute care Clinical group practice management Hospitalist +81

Exec Senior Full Time

USD 223K+

Senior RX Clinical Programs Pharmacist
Remote US

Medication therapy Home health services Development programs Medication Adherence Clinical programs Health outcomes Prescription Home Health Microsoft Office Applications +53

Senior Full Time

USD 104K+

Formulary Systems Coordinator
LOUISVILLE, KY, United States

BrightSpring Health Services

Healthcare Informatics Project Six Sigma Pharmacy Lean Typing Managed Care Administration Process Improvement +7

USD 80K+

Diabetes Sales Specialist -- Alexandria, LA
United States of America : Remote

Nutrition Products Glucose Monitoring Informatics systems Molecular diagnostics Interventional Pain Therapy Mobile technology Implantable devices Cardiac Rhythm Technologies Quality System +35

USD 64K+

Claims Examiner
Recruiting Only - Telecommuter

Action plans Strategic vendor partnerships Claims coding Social Security Insurance principles Cost Containment Litigation management Adjudication Interpretive +29

USD 41K+

Part-Time Weekend Medical Director (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Clinical software General computer Telephone Disease Management Listening Utilization management Oral communication Health Insurance Public health +13

Exec Mid Part Time

USD 170K+

Medical Director, Clinical Strategy, Diagnostic Imaging
United States

Cohere Health Remote-first

Clinical outcomes Content Ideation Healthcare partnerships Clinical program design Software tools Clinical Quality Clinical Strategy Quality Metrics Diagnostic Imaging +27

Exec Senior Full Time

USD 250K+

Public Health Nursing Consultant
REMOTE OPTIONS, PHOENIX

State of Arizona

Health care services Operational reviews Federal and State Statutes Review Medicaid regulations Quality of care Healthcare quality Hybrid Policies and procedures +47

USD 72K+

Senior Revenue Cycle Analyst (Remote in the US or hybrid based if local to Dallas, TX)
United States

Tenet Healthcare

Patient Accounting Cerner EHR CPT codes Registration Revenue Cycle HCPCS Revenue Cycle Management CPT Claims processing +20

Senior Full Time

USD 89K+

Case Manager- Wisconsin Rapids
Work at Home - Wisconsin

Driver safety program Community Resource Coordination Care Plan Development Social service care management Community integration Family Care Health and wellness Social services Prevention +41

USD 47K+

Case Manager - Baraboo/Mauston, WI
Work at Home - Wisconsin

Driver safety program Electronic Case Note Documentation Electronic Information Applications Social service agencies Microsoft Office Word Health promotion Family Care Community Health Care Planning +46

USD 47K+

Senior Data Visualization Engineer
Remote US

Data algorithms Qlikview User Interfaces SPSS Modeling techniques Data Extraction Visualizations Hadoop Software Applications +48

Senior Full Time

USD 78K+

Care Coach- Shawano
Work at Home - Wisconsin

Driver safety program Social service care management Community integration Family Care Health and wellness Prevention Human services Enrollment Risk +37

USD 47K+

Case Manager - Superior, WI
Superior

Driver safety program Employment support Housing support Community Resource Coordination Health and Wellness Coordination Community integration Social service care management Health and wellness Family Care +40

USD 47K+

LPN - Prior Authorization
Work At Home-Texas

Digital charting Medical Services Pharmacy benefits Pharmacist Navigating multiple systems Keyboarding Phone LVN Clinical Criteria +28

USD 44K+

Clinical Transformation Consultant (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Gap Assessment Health Care Delivery Clinical transformation Consultative Services Autonomy Performance analysis Conflict Resolution Healthcare industry Health Insurance +23

Senior Full Time

USD 57K+

Care Manager Behavioral Health - Part Time (Weekends) Remote
PA, Working at Home - Pennsylvania

Highmark Health

Health care services Condition Management Health coaching Utilization management Care management RN Health Insurance Nursing Managed Care +15

USD 50K+

Diabetes Sales Associate - Phoenix(East), AZ
United States of America : Remote

Nutrition Products Glucose Monitoring Interventional Pain Therapy Molecular diagnostics Informatics systems Implantable devices Mobile technology Cardiac Rhythm Technologies Healthcare Sales +36

USD 57K+

Regional Sales Director, US Sales – Hematology Franchise (West)
Remote (US)

Cross-functional experience National accounts Strategic focus Medicare part d Hospital markets Injectables Iv medications Specialty sales Orals +40

Exec Senior Full Time

USD 196K+

Utilization Management Nurse Consultant
Work At Home-Washington

Med/surg Coverage determination Long Term Care Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Telemetry +30

Senior Mid Full Time

USD 64K+

Virology Customer Representative - Washington D.C. Mirror
USA - Pennsylvania - North Wales (Upper Gwynedd)

Virology Products Ethics Compliance Customer needs assessment Virology Payer Environment Health outcomes Customer segmentation IDS Technology Utilization +46

Senior Mid Full Time

USD 101K+

Reviewing Medical Director
Remote US

Grievance processes Care facilitation Post-acute services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Post-acute care Inpatient rehabilitation +93

Exec Senior Full Time

USD 199K+

Community Resource Coordinator- Janesville, WI
Work at Home - Wisconsin

Internet service management Driver safety program Face-to-face assessments Health and Wellness Coordination Community integration Social service care management Family Care Health and wellness Prevention +36

USD 47K+

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