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Managed Care Remote Jobs

265 fresh jobs found

RN, Field Care Manager - Tidewater Region, Virginia
Work at Home - Virginia, United States

Face-to-face evaluations Evidence-based strategies Face-to-face assessments Web navigation Keyboard Advanced Computer Telephonic assessments Electronic Information Applications Social service agencies +66

USD 25K+

RN, Field Care Manager - Northern/Winchester, Virginia
Work at Home - Virginia, United States

Face-to-face evaluations Evidence-based strategies Face-to-face assessments Web navigation Keyboard Advanced Computer Telephonic assessments Electronic Information Applications Social service agencies +66

USD 25K+

Government Healthcare Financial Consultant
Phoenix - E. Camelback, United States

Healthcare financial analysis Rate setting Retirement Healthcare Consulting Retirement programs Power Advising Managed Care Law +15

USD 68K+

Care Manager RN, Physical Health
Work at Home - Ohio, United States

Clinical Intervention Telephonic Assessment Transitions of Care Web navigation Keyboard Judgement Holistic care Advanced Computer Electronic Information Applications +63

USD 71K+

Director of Provider Services
Work at Home - Illinois, United States

Claims Education Provider performance Provider communications Claims analysis Team performance Human services Strategic Mindset Provider education Surveys +76

Exec Senior Full Time

USD 138K+

RN, Field Care Manager - Southwest Roanoke/Alleghany Region
Work at Home - Virginia, United States

Face-to-face evaluations Evidence-based strategies Face-to-face assessments Web navigation Keyboard Advanced Computer Telephonic assessments Electronic Information Applications Social service agencies +67

USD 25K+

Field Care Manager - BH
Glen Allen - VA, United States

Face-to-face assessments Advanced Computer Electronic Information Applications Peer support Social service agencies Human services Medical Services Health outcomes Care Planning +73

USD 59K+

Diabetes Sales Specialist-Boston-South, MA
United States of America : Remote

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

USD 66K+

Talent Management Program Manager III
Remote-MO, United States

Centene Corporation

Evaluation criteria Project documentation Success metrics Project Implementation Project Execution Project management tools Healthcare administration Requirements Gathering Talent Management +23

Senior Mid Full Time

USD 86K+

Prior Authorization Pharmacy Technician - Remote
Any city, OR, US, 99999

Gainwell Technologies

Provider Prior authorizations Pharmacy Technician Call center Operations Pharmacy benefit management Prior authorization Processes Cross-functional Teams HIPAA Compliance +28

USD 35K+

Insurance Billing/Collections Assistant II (Remote) - Program in Physical Therapy
Remote - Missouri, United States

Washington University in St. Louis

Medicare plans Telephone communications Health insurance billing Epic ehr Confidential data handling Medical billing and coding Collections strategies Data Handling Insurance follow-up +36

USD 50K+

Arizona PDL Health Data Analyst Senior - Remote
Home, United States

Prime Therapeutics

NCPDP data Managed care organizations NCPDP Data Research Analytical Modeling Pharmacy benefits management Benefits consulting Healthcare Analytics Pharmacy benefit management +29

Senior Full Time

USD 81K+

Operations Associate I
Remote, TN, United States

Patient accounting systems Reconciliation reporting Payment screenings Workflow tracking Denials Accounting Systems Data acquisition Medicare Advantage Acute care +17

Entry Mid Full Time

USD 40K+

Benefit Support Analyst III (Implementation)
Dayton WFH, United States

Medical business analysis ICD-CM coding ICD-CM Codes Database relationships Benefit configuration Facets Hcpcs coding Regulatory knowledge CPT coding +34

Senior Mid Full Time

USD 70K+

Provider Engagement Account Manager
Remote-LA, United States

Centene Corporation

Consultative account management Demographic information changes Cost and utilization Claims Submission Network performance Quality measures Provider education Provider Relations Utilization +31

USD 55K+

Field Care Manager, ARTS
Glen Allen - VA, United States

Face-to-face assessments Peer support Advanced Computer Electronic Information Applications Substance use services Social service agencies Medical Services Substance use Care Planning +65

USD 59K+

Executive Director, Outcomes Research, Pneumococcal Vaccines
USA - Pennsylvania - North Wales (Upper Gwynedd), United States

Meta-analyses Economic Modelling Value evidence strategies Systematic Reviews Economic evidence Pharmacoeconomics Healthcare Resource Utilization Health technology assessment Hta +55

Exec Senior Full Time

USD 250K+

Regional Lead Patient Access - KRYSTEXXA - Northeast (Rare Disease)
US - New York - New York - Field/Remote, United States

Direct patient care Reimbursement processes Healthcare provider education Strategic direction Pharma Patient services Inflammation Therapeutic Areas Rare Disease +38

Senior Full Time

USD 188K+

Medi-Cal Operations Manager
California

Medi-cal programs Operational Oversight Culturally competent care Healthcare Delivery Social services Community Health Virtual care Community Engagement Contract management +6

USD 120K+

Director, Clinical Quality and Practice Optimization
Remote

Care delivery Interdisciplinary Collaboration Health Equity Clinical Quality Culturally competent care EHR systems Workflow Design Social services Performance Tracking +14

Exec Senior Full Time

USD 150K+

Patient Account Representative-Remote
United States

Tenet Healthcare

Third party payors Account resolution ACE Claim Submission Remittance review Insurance collections HCFA 1500 Patient financial services UB04 +39

Entry Mid Full Time

USD 47K+

Manager-Transition of Care (Full time Remote, North Carolina Based)
Charlotte, North Carolina, United States; Morrisville, North Carolina, United States; Fayetteville, North Carolina, United States; Smithfield, North Carolina, United States; Remote, North Carolina, United States

Alliance Health

Workflow Organization Transitional care management Evidence-based practice Staff management Population health Discharge planning Program development Utilization Review ICD-10 +32

USD 86K+

Tele-Triage Registered Nurse - RN
LOUISVILLE, KY, United States

BrightSpring Health Services

Home health nursing Tele-triage Symptom assessment Nursing care plans Patient Communication Developmental disabilities Home Health Care Plans Triage +17

USD 60K+

Senior Health Outcomes Researcher - Remote
Home, United States

Prime Therapeutics

Healthcare claims analysis Research Reporting Client Presentation Data Research Clinical study design Healthcare Claims Epidemiology Statistical modeling Statistical analysis +22

Senior Mid Full Time

USD 108K+

Associate Vice President, Quality Operations(Preferred Managed Care Experience)
Dayton WFH, United States

Systematic Thinking Strategic management Healthcare quality Critical Listening Problem identification NCQA HEDIS Accreditation Resolution +25

Senior Mid Full Time

USD 150K+

Complex Denials Consultant
Remote, MD, United States

Payer-provider relations Appeals process Healthcare providers Denials Reimbursement methodologies Contract Review Workflow Orchestration Intelligent Automation Legal writing +18

USD 78K+

Senior Clinical Research Analyst - Remote
Home, United States

Prime Therapeutics

Healthcare Claims Data Medical claims data Healthcare Claims Epidemiology Google Cloud Platform Claims Technical Solutions Mathematics Clinical Research +20

Senior Full Time

USD 81K+

Utilization Management - Behavioral Health Professional
Work at Home - Louisiana, United States

Interpreting Criteria Advanced Computer Electronic Information Applications MCG Social service agencies Health promotion Medical Services Bilingual English/Spanish HireVue +55

USD 65K+

Dental Recontracting Professional - VSP
Work at Home - Kentucky, United States

Assist Provider Contracting Analyzing Managed Care Contracts Consumer Experiences Staffing BI Negotiating Contracting +30

USD 65K+

Market Leadership Advisor
Remote US, United States

Medicaid Operations Medicaid Experience Functional strategies Assist Health benefits HireVue Financial Performance Healthcare administration Functions +49

Senior Mid Full Time

USD 126K+

SIU Lead Investigator
Remote-PA, United States

Centene Corporation

Audit analysis Medical claims coding Xcelys Government programs Pharmacy Technician Medical claims Guidelines Microsoft Access Investigative +40

Senior Full Time

USD 68K+

Senior Data Scientist
Remote MA BOSTON, United States

DataRobot Time Series Random Forest Cluster analysis Gradient boosting Predictive models Statistical models Regression analysis Business Insights +86

Senior Full Time

USD 141K+

CQE Manager I-Rehab Services-Occupational Therapy (Remote)
United States

American Specialty Health, Inc.

Evidence-Based Principles Medical Necessity Review Clinical Decision Making Occupational Therapy Performance Improvement Interpersonal Communication Quality Management Managed Care Confidentiality +6

Senior Mid Full Time

USD 69K+

Operations Auditor II
Remote-FL, United States

Centene Corporation

Corrective Actions Applied Behavioral Analysis Behavioral Analysis ABA Accreditation Healthcare Compliance Credentialing Information systems Procedures +25

USD 55K+

Interoperability Strategy Lead
Remote US, United States

Consulting experience Matrixed environment Strategy Consulting Research and Analysis Interoperability Strategic Analysis Qualitative analysis Articulate HireVue +43

Senior Mid Full Time

USD 115K+

Manager, Strategic Provider Partnerships
Remote-OR, United States

Centene Corporation

Clinical workflow optimization Performance Insights Value-based contracting Member Outreach Utilization Provider engagement Health Plan Clinical Experience Healthcare administration +22

USD 86K+

Credit Resolution Representative - Remote
United States

Tenet Healthcare

Self-pay Pbar Star Third party payors Payor regulations Refund analysis Meditech ACE HCFA 1500 +31

Entry Full Time

USD 51K+

Patient Account Representative - Remote
United States

Tenet Healthcare

Third party payors Account resolution ACE Remittance review Claim Submission HCFA 1500 Insurance collections Patient financial services UB04 +41

Entry Mid Full Time

USD 47K+

Director, Consulting - California Medicaid (Medi-Cal) Program & Policies - Hybrid/Remote
Sacramento, CA; Remote (California, US)

Medicaid financing Healthcare Consulting Healthcare policy Consulting Services Public Policy Operational Support Public health Managed Care Medicaid +16

Exec Senior Full Time

USD 154K+

Supervisor, Reimbursement - Follow Up & Appeals - Screening (Monday - Friday)
Remote, N/A, United States

Guardant Health

Laboratory billing Payer Portals Xifin Billing Processes Clinical Laboratory Claims management SOPS Collections Medical terminology +31

USD 83K+

Territory Leader - California North
Sacramento, California, United States

Tarsus Pharmaceuticals, Inc.

Pull through tactics Feedback sharing Product trial Business ownership Optometry Ophthalmology Resource Utilization Disease State Education Sales Execution +17

Senior Mid Full Time

USD 108K+

Territory Leader - Phoenix Northwest
Phoenix, Arizona, United States

Tarsus Pharmaceuticals, Inc.

Pull through tactics Product trial Business ownership Optometry Ophthalmology Resource Utilization Disease State Education Sales Execution Medical Affairs +15

Senior Mid Full Time

USD 108K+

Internal Auditor I (Full-time Remote, North Carolina Based)
Morrisville, North Carolina, United States; Remote, North Carolina, United States; Charlotte, North Carolina, United States; Smithfield, North Carolina, United States; Fayetteville, North Carolina, United States

Alliance Health

Grievance Management Audit Methodology Audit software Internal Auditing Investigative Techniques Evidence Gathering Interviewing Internal Controls Care management +23

Entry Mid Full Time

USD 66K+

Pharmacy Technician - Remote
United States

Tenet Healthcare

Pharmacy Technician ICD-10 Coding HCPCS ICD-10 Fast-paced Environment CPT Managed Care Technical Training Authorization +11

USD 51K+

Physician Medical Billing Specialist - Remote
United States

Tenet Healthcare

Third party payors Account resolution ACE Remittance review Claim Submission HCFA 1500 Insurance collections Patient financial services UB04 +41

Entry Mid Full Time

USD 47K+

PBM Sr. Manager, Informatics
United States

Navitus Health Solutions, LLC

Geo-access Analysis PC2 Network Pricing Contracting Strategy Qlikview Risk Analysis CMS Audits Health +19

Senior Full Time

USD 93K+

Supervisor, Integrated Care Management
Sentara Health Plans Richmond - Remote, United States

Behavioral health services Health Plan Experience RN license Educational Services BLS Health Plan Supervisory Care Coordination RN +19

USD 127K+

Quality Program Strategist II
Remote-MO, United States

Centene Corporation

Performance goals CAHPS HOS Quality performance Cphq HEDIS Health Plan Clinical Experience Cross-functional Teams +30

USD 68K+

Manager, Operations (Medicaid / FIDE SNP)
Remote-NJ, United States

Centene Corporation

Xcelys Pricing Configuration Total quality management Amisys Data Sources Benefits management Matrix Environment Tracking Methodologies +33

USD 86K+

Finance Analyst III - Hybrid
Remote-OH, United States

Centene Corporation

Finance analysis Statistical reporting Financial data analysis MicroStrategy PeopleSoft Microsoft Access OneStream General Ledger Data Warehouse +26

Senior Mid Full Time

USD 68K+

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