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Managed Care Remote Jobs

271 fresh jobs found

Public Health Nursing Consultant - Quality Assurance
REMOTE OPTIONS, PHOENIX, TUCSON

State of Arizona

Federal and State Statutes Medicaid regulations Healthcare quality Medicaid programs Policies and procedures Arizona Administrative Code Quality of care Review Performance measures +52

USD 72K+

Public Health Nursing Consultant - Case Management
REMOTE OPTIONS, PHOENIX

State of Arizona

Federal and State Statutes Medicaid regulations Healthcare quality Medicaid programs Data Tracking Policies and procedures Arizona Administrative Code Quality of care Review +53

USD 72K+

Coordinator I, Recoveries
United States

Navitus Health Solutions, LLC

Benefit configuration Report creation Claims Adjudication Client Services Claims processing Health Pharmacy Managed Care Auditing +9

Entry Mid Full Time

USD 48K+

Analyst, Pricing and Underwriting
United States

Navitus Health Solutions, LLC

Performance Improvement Pricing strategy Health Statistical analysis Pharmacy Database Management Managed Care Financial modeling Business Analysis +16

Entry Mid Full Time

USD 58K+

Diabetes Sales Specialist -- Huntsville, AL
United States of America : Remote

Molecular Glucose Monitoring Interventional Pain Therapy Implantable devices Nutrition Products Informatics systems Mobile technology Medical technologies Heart failure +38

USD 66K+

Licensed Clinical Social Worker - Accredo - Remote
Pennsylvania Work at Home, United States

The Cigna Group

Motivational Strategies Administrative Abilities Health Behavior Change Theories Telephonic counseling Wellness coaching Managed Care Knowledge Psychosocial assessments Licensed Clinical Social Worker Cigna +47

Senior Mid Full Time

USD 56K+

Integrated Nurse Case Manger
Sentara Health Plans Richmond - Remote, United States

Chronic Illness Management RN license Telephonic assessments Clinical assessments Health Plan Care Coordination RN Care management Coordination +16

USD 111K+

Manager, Claims & Contract Support Services
Remote-GA, United States

Centene Corporation

Contract implementation Claims Administration Provider Contracting Software Upgrades Provider Relations Business solutions Health Plan Workflow Management Claims +20

USD 86K+

Provider Engagement Account Manager
Remote-WA, United States

Centene Corporation

Consultative account management Demographic information changes Cost and utilization Quality measures Network performance Provider education Provider engagement Utilization Provider Relations +30

USD 55K+

Quality Improvement Analyst.
Remote-NV, United States

Centene Corporation

Service utilization Statistics software Public sector managed care Performance Data NCQA Accreditation HEDIS measures Cphq Healthcare quality Business Process +28

Entry Mid Full Time

USD 55K+

Diabetes Sales Specialist - Charleston, SC
United States of America : Remote

Molecular Glucose Monitoring Interventional Pain Therapy Implantable devices Nutrition Products Informatics systems Mobile technology Medical technologies Heart failure +38

USD 66K+

Business Analyst - Medicaid Claims
Any city, WI, US, 99999

Gainwell Technologies

Programming concepts Relational Database Software Computer Programming Analytical Software ALM Re-engineering Process re-engineering Batch Relational database +40

Entry Mid Full Time

USD 55K+

VP, Market Operations(Must Live In Ohio)
Ohio WFH, United States

Organizational support Plan management Operational tactics Product oversight Systematic Thinking Implementation Strategy Program strategy Strategic management Health Plan Operations +38

Exec Senior Full Time

USD 150K+

Diabetes Sales Associate -- Green Bay, WI
United States of America : Remote

Molecular Glucose Monitoring Interventional Pain Therapy Implantable devices Nutrition Products Informatics systems Mobile technology Medical technologies Heart failure +40

USD 60K+

Team Lead, Market Liaison Support Services
Dayton WFH, United States

Microsoft Visio Healthcare operations Certification Visio Claims processing Claims Facilitation Prioritization Managed Care +25

Senior Mid Full Time

USD 70K+

Sr. Manager, Value-Based Care Operations
Remote, USA, United States

Operational training Payer contracting HIPAA rules and regulations HIPAA Rules Technology-driven Cloud-based technology Strategic Relationships Risk Adjustment Population health +26

Senior Mid Full Time

USD 95K+

Quality Assurance Investigative Nurse (Qa District Nurse)
REMOTE OPTIONS, TUCSON

State of Arizona

Health & Safety Inspections Investigative Nursing Interviewing techniques Arizona Revised Statute Quality of care Performance measures Investigative Equal Opportunity Eligibility verification +44

USD 66K+

UM Coordinator 2
Remote US, United States

Assist Computations ICD-10 codes Process Flows ICD Clinical Information Microsoft Office Applications Medical necessity Processes +54

Entry Mid Full Time

USD 40K+

Manager, Provider Performance Program Management
Ohio WFH, United States

Sdoh URAC Provider network Health Equity Quality Metrics Provider engagement NCQA Accreditation Healthcare Knowledge +37

USD 81K+

Sr. Analytics Analyst
Remote, IL, United States

Revenue cycle analytics V-lookups Standardization Revenue cycle operations Workflow Orchestration Pivot Tables Healthcare Data Intelligent Automation PowerBi +30

Senior Mid Full Time

USD 51K+

Vice President, Children's Health-Care Management
Remote-FL, United States

Centene Corporation

Health outcomes initiatives Medicaid compliance Population health strategy Executive leadership Provider contracts UM Quality Initiatives Compliance requirements Clinical programs +57

Exec Senior Full Time

USD 182K+

Referral Coordinator NRU
Working Virtually, United States

MultiCare Health System

Insurance plan guidelines Medical guidelines Good judgment ICD coding Professional Communication CPT coding Judgment CPT Referrals +16

USD 42K+

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

Centene Corporation

Personalized care plan Quality care Service coordination Complex Care Management Service plan Healthcare Coordination Healthcare outcomes Service plans Healthcare benefits +29

Senior Mid Full Time

USD 73K+

Operations Auditor
Remote-AR, United States

Centene Corporation

Corrective Actions Accreditation Information systems Procedures Data integrity Managed Care Auditing Risk Assessment Audit +13

USD 44K+

Quality Improvement Coordinator - Behavioral Health
Remote-WA, United States

Centene Corporation

Complaints resolution Appeals management Quality Initiatives CDP Grievances Clinical quality improvement Clinical Nursing Clinical Quality Program Evaluation +28

USD 66K+

Business Analyst III Claims Configuration
Remote-MO, United States

Centene Corporation

Provider reimbursement methodologies Managed Care Information Structured Testing Claims Configuration Business implementation Implementation processes Process redesign Operational reporting Reimbursement methodologies +38

Senior Mid Full Time

USD 68K+

Provider Contracting Professional
Remote US, United States

Medicaid contracting Provider Recruitment Assist Provider Contracting Managed Care Contracts Home Care Analyzing Independent work Risk +38

USD 65K+

Diabetes Sales Specialist-Syracuse, NY
United States of America : Remote

Molecular Glucose Monitoring Interventional Pain Therapy Implantable devices Nutrition Products Informatics systems Mobile technology Medical technologies Heart failure +38

USD 66K+

Quality Program Strategist II
Remote-NY, United States

Centene Corporation

Performance goals HOS CAHPS Quality performance Cphq HEDIS Health Plan Clinical Experience Cross-functional Teams +29

USD 68K+

Senior Medicare Communications Compliance Specialist
Remote-FL, United States

Centene Corporation

Health care administration Medicare Compliance Regulatory Analysis Medicare part d Health administration Guidelines Project leadership Project Coordination Public health +22

Senior Full Time

USD 68K+

Platform Associate
Remote, USA, United States

EHR support Athenahealth Technology-driven HIPAA rules and regulations HIPAA Rules Cloud-based technology Remote Support Practice Management Athena +20

Entry Mid Full Time

USD 60K+

Internal Provider Auditor
Houston, TX, United States

Microsoft Access Healthcare Compliance Predictive Analytics Managed Care Auditing Supervision Microsoft Word Reimbursement Microsoft Excel +8

Entry Mid Full Time

USD 43K+

Remote Contractual Compliance Coordinator
Lexington, KY, United States

APC pricing Coding edits ICD coding CPT coding Microsoft Access Healthcare Compliance Predictive Analytics Claims processing Managed Care +14

USD 45K+

Remote Contractual Compliance Coordinator
Missouri City, MO, United States

APC pricing Coding edits ICD coding CPT coding Microsoft Access Healthcare Compliance Predictive Analytics Claims processing Managed Care +15

USD 45K+

Claims Director
Home Based, US

Davies North America Remote-first

Stop loss CMS regulations Pharmacy benefits Claim processing Medical claims Medical terminology Editing Managed Care Auditing +16

Exec Mid Full Time

USD 75K+

Patient Account Senior Representative - Remote
United States

Tenet Healthcare

EOB interpretation Team support Insurance terminology UB-04 Remittance review Insurance collections Claim Submission Insurance Billing Patient financial services +40

Senior Full Time

USD 51K+

Medical Billing Specialist - Remote
United States

Tenet Healthcare

Account resolution Productivity standards Data documentation Remittance review ACE Claim Submission Insurance collections HCFA 1500 UB04 +42

Entry Mid Full Time

USD 47K+

Denial Management Specialist - Remote
United States

Tenet Healthcare

Account resolution Remittance review ACE Insurance collections Claim Submission HCFA 1500 UB04 Patient financial services Denial Management +42

Entry Mid Full Time

USD 47K+

Physician Billing Specialist - Remote
United States

Tenet Healthcare

Account resolution Remittance review ACE Insurance collections Claim Submission HCFA 1500 UB04 Patient financial services Patient Accounting +40

Entry Mid Full Time

USD 47K+

Denial Follow-up Specialist - Remote
United States

Tenet Healthcare

Account resolution Remittance review ACE Insurance collections Claim Submission HCFA 1500 UB04 Patient financial services Patient Accounting +40

Entry Mid Full Time

USD 47K+

Credentialing & Provider Enrollment Specialist
Remote

Provider Enrollment Commercial Insurance Enrollment Healthcare administration Credentialing Detail oriented Microsoft Outlook Managed Care Behavioral health +16

USD 44K+

Manager, Infusion Services
United States

Navitus Health Solutions, LLC

Pharmacy Management Nursing Coordination Billing procedures Staff training Performance Improvement Patient services Specialty Pharmacy Operations Management Policy Development +19

USD 120K+

Senior Professional Nurse
Topeka, KS, US, 66619-1448

Gainwell Technologies

Billing audits DRG coding Medical Review Provider education DRG Accuracy ICD-9 Utilization Review HCPCS +33

Senior Full Time

USD 64K+

Case Manager - Sparta/Tomah, WI
Work at Home - Wisconsin, United States

Case Note Documentation Electronic Case Note Documentation Electronic Information Applications Family Care Microsoft Office Word Social service agencies Health promotion Care Planning Human services +52

USD 53K+

Medical Director - Southeast Region
Remote US, United States

Health claims Clinical patient care Health claims review Computer-Based Review Post-acute services Outpatient services Grievance and appeals processes CMS policies Post-acute care +90

Exec Senior Full Time

USD 223K+

Senior Lead Pharmacist (PBM) Consultant
Chicago - 155 Wacker, United States

Client-Facing Experience Pharmacy benefits management Plan Design Pharmacy benefit management Retirement programs Benchmarking Power Advising Law +19

Senior Full Time

USD 174K+

Manager, Payment Integrity - Implementations
Remote-MO, United States

Centene Corporation

Medical claim investigation Fraud and abuse Payment Integrity Medical Coding Health Plan Data Mining Financial Claims processing Medical terminology +25

USD 86K+

Case Manager- Dane County
Work at Home - Wisconsin, United States

Wellness coaching Electronic Case Note Documentation Case Note Documentation Social service care management Family Care Electronic Documentation Prevention Community integration Social service agencies +48

USD 53K+

Contract Implementation Analyst
Remote-IA, United States

Centene Corporation

TPA Contract implementation Provider information system Provider contracts Amisys UAT Government programs Claims payment Claims analysis +25

Entry Mid Full Time

USD 44K+

School-Based Service Administrator
Remote-IN, United States

Centene Corporation

Health care administration Consultative Services Health care services Social services Population health Partnership development Social Work Workflow Management Quality improvement +17

USD 68K+

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