FreshRemote.Work

Sign in

Managed Care Remote Jobs

126 fresh jobs found

Senior Manager Pharmacy Business *Remote*
Portland, OR, United States

Lean training Managed care pharmacy Cap/workout™ methodologies Legal and regulatory matters Contractual management Healthcare administration Cross-functional Team Leadership Supervisory Lean +13

Senior Full Time

USD 94K+

Behavioral Health - Utilization Management Clinical Consultant - KY
Work At Home-Kentucky

Clinical Practice Guidelines Benefit management Benefit utilization Navigating multiple systems Clinical Criteria Utilization Review Evidence-Based Care Keyboarding Clinical Practice +22

USD 52K+

Insurance Billing/Collections Assistant II (Pre-Arrival Team/Remote) - Program in Physical Therapy
Remote - Missouri

Washington University in St. Louis

Third party payers Confidential data handling Epic applications Telephone system Medical billing and coding ICD coding Organizing Insurance Billing Data Handling +27

USD 34K+

Utilization Management Nurse Consultant
Work At Home-Nevada

Clinical Judgement Long Term Care Benefit management Benefit utilization Home Health Clinical Criteria Acute care Prior authorization Call Center Experience +15

USD 58K+

Senior Applications Developer (UNIX/C/MMIS)
Any city, CO, US, 99999

Gainwell Technologies

Database methodologies MMIS Application implementation Unix/Linux Application design Processes Technical Consulting Edge Claims +35

Senior Full Time

USD 90K+

Provider Relations Specialist
Remote-US, California, United States

Alignment Health

Access database HCC coding Data submission Referral management HEDIS Provider Relations Supervisory Claims management MS Word +7

USD 60K+

Senior Director, Corporate FP&A
Remote

Cost allocation Financial strategy Management Reporting Technology Platform Financial Performance Efficiency Managed Care Health Insurance Netsuite +24

Senior Full Time

USD 172K+

Diabetes Sales Associate- Buffalo, NY
United States of America : Remote

Glucose Monitoring Interventional Pain Therapy Nutrition Products Informatics systems Neuromodulation Heart failure Implantable devices Quality System Mobile technology +32

USD 57K+

Care Manager - RN
New Albany-7400 West Campus Road

Telephonic assessment Clinical coverage Spanish Speaking RN license Clinical Tools Holistic approach Clinical resources RN licensure Acute care +20

Senior Mid Full Time

USD 60K+

Care Manager RN - (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Health coaching Clinical Experience Utilization management Care management Healthcare services Managed Care Case Management HIPAA Clinical +12

USD 50K+

Clinical Research Scientist
Remote US

Recommender system Spark r Spark/Scala Clinical Informatics Judgement Recommender Systems Analyzing Network Analysis Clinical Strategy +63

USD 69K+

Lead Data Scientist
Remote US

Gradient boosting Cost of care analysis Datarobot Time Series Predictive models Regression analysis Random Forest Statistical models Cluster analysis +61

Senior Mid Full Time

USD 126K+

Appeals Nurse Consultant (Remote)
Work At Home-Pennsylvania

Pre authorization Appeals Pre-certification RN licensure Medical necessity Computer Systems Utilization management RN Clinical Experience +10

USD 60K+

UM Nurse Consultant
Work At Home-Texas

Benefit utilization Benefit management Coverage determination RN licensure Navigating multiple systems Clinical Criteria Keyboarding Discharge planning Registered Nurse +16

USD 58K+

Inpatient Review Nurse (RN/LVN) Must have California Licensure
Remote-US, California, United States

Alignment Health

Inpatient review Milliman care guidelines Concurrent review Managed Care Plans LVN California licensure Medicare managed care plans Medicare Managed Care Utilization management +17

USD 74K+

Area Director Business Development - WI, MI, Northern IL, and Northwest IN
USA - IL - Itasca - 150 Spring Lake Drive

Clinical Diagnostics Value-based care P&L Management Healthcare Sales Commercial Strategy KPIs Strategic partnerships Managed Care People Management +12

Exec Senior Full Time

USD 175K+

Clinical Program Advisor - Express Scripts - Remote (Medicare)
New Jersey Work at Home

The Cigna Group

Clinical Program Management Claims Adjudication Reporting tools Analytic Care Coordination Listening Administrative Pharmacy Analytical thinking +33

USD 92K+

Social Work Care Coach - La Crosse, WI
Work at Home - Wisconsin

Electronic Information Applications Microsoft Office Word Electronic Case Note Documentation Social service agencies Social services Health promotion Family Care Human services Care Planning +44

USD 47K+

Information Technology Quality Engineer I (Full time Remote, North Carolina Based)
Morrisville, North Carolina, United States; Remote, North Carolina, United States; Fayetteville, North Carolina, United States; Charlotte, North Carolina, United States

Alliance Health

Test Case Design Statistical Process Control Quality Engineering Triage Release Management Software testing User Acceptance Testing Test Automation Quality improvement +18

Entry Mid Full Time

USD 65K+

Internal Auditor II (Full-time Hybrid/Remote, North Carolina Based)
Morrisville, North Carolina, United States; Smithfield, North Carolina, United States

Alliance Health

Internal audit software Audit Methodology Credentialing Interviewing Internal Controls Report Writing Managed Care Auditing Medicaid +18

Entry Senior Full Time

USD 86K+

Director Account Management and Pricing Strategy - Remote
Remote Position (USA)

Stakeholder research Financial Evaluation Contract execution Market Access Strategies Contracting Strategies Healthcare Contracting Healthcare economics Access and Reimbursement Account Development +35

Exec Senior Full Time

USD 212K+

Behavioral Health Case Management Coordinator (RICHARDSON – TELECOMMUTER/REMOTE)
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Bilingual English/Polish Health Case Management Familiarity with Ancillary Services Database experience Bilingual English/Spanish Discharge planning Clinical Practice Registered Nurse Clinical Care +19

USD 58K+

GI Key Account Manager - Charlotte/Columbia
USA - NC - Virtual

Biological product launch Specialty sales Managed markets Gastroenterology Healthcare Professionals Reimbursement Issues Healthcare Knowledge Pharmaceuticals Managed Care +18

USD 154K+

Senior Data Scientist
Remote US

Datarobot Statistical models Business Insights LLM PySpark GenAI Trend Analysis Dental Vision +66

Senior Full Time

USD 104K+

Primary Nurse Case Admin I (NICU Speciality) - Health Advocacy Solutions
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

NICU specialty RN license Coordination of care Wellness education Database experience Medical Management Policies Lotus Notes Milliman guidelines Condition Management +27

USD 58K+

Care Management Associate (Fully remote in Florida)
Work At Home-Florida

Qnxt Dynamo Aetna systems Medical Services Computer literacy Regulatory standards Care Coordination Medical terminology Effective Communication +20

Entry Mid Full Time

USD 36K+

Clinical Sales Specialist - IBD (Pittsburgh South/West Virginia)
USA - WV - Virtual

Biological product launch Reimbursement management Injectable products Managed Care Landscape Specialty sales Therapeutic Strategies Business Expertise Managed markets Gastroenterology +22

USD 117K+

Holistic Health Specialist - HAS - Richardson, TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Member Education Holistic Health MCG Certification Coordination of care Wellness education Database experience Medical Management Policies Condition Management Lotus Notes +25

USD 58K+

Utilization Management Clinician Behavioral Health
Work At Home-Pennsylvania

Clinical Practice Guidelines Healthcare services coordination Benefit utilization Benefit management Coverage determination Clinical Criteria Utilization Review Evidence-Based Care Clinical Practice +14

USD 60K+

Medicare Grievances and Appeals Corporate Medical Director
Remote US

Preservice appeals General surgery Health claims Medical interpretation Family practice Hospitalist Medical background Emergency Medicine Geriatrics +35

Exec Senior Full Time

USD 241K+

Field Case Manager I - King County
Seattle, Washington, United States

Community Health Plan of Washington

Care management software Medicaid regulations Home Health Medicare Advantage Discharge planning Community Resources Software Applications Social Work Care Coordination +12

USD 77K+

Pre-Certification Coordinator II - DOM - Business Office
Remote - Missouri

Washington University in St. Louis

Patient benefits Organizational savvy Insurance eligibility Payer policies Epic ehr Authorization process Oncology drugs Non-oncology drugs External customers +20

USD 68K+

Credentialing Specialist
remote, USA, United States

Primary source verification HIPAA rules and regulations HIPAA Rules Cloud-based technology Technology-driven Report Preparation Credentialing CMS Managed Care +7

Entry Mid Full Time

USD 50K+

Operating Effectiveness Lead Analyst - eviCore - Remote
New York Work at Home

The Cigna Group

Workflow Documentation Medical Claims Operations Healthcare economics Smartsheet Management consulting Quality improvement Verbal and written communication Pharmacy Visio +26

Senior Mid Full Time

USD 72K+

UM Nurse Consultant (Remote)
Work At Home-Iowa

Navigating systems Benefit utilization Benefit management Coverage determination RN licensure Navigating multiple systems Clinical Criteria Keyboarding Registered Nurse +17

USD 52K+

Medicaid Implementation Sr Business Project Manager
Remote US

Business process change management Operational decision making Prosci Network Implementation Systems Development Life Cycle Consulting Services Functions Business Process Dental +40

Senior Full Time

USD 84K+

Diabetes Sales Associate -- Cincinnati, OH
United States of America : Remote

Interventional Pain Therapy Glucose Monitoring Informatics systems Nutrition Products Neuromodulation Quality System Heart failure Implantable devices Mobile technology +32

USD 57K+

Medical Director--Claims Management
Remote US

Medicare Guidelines Inpatient Care Grievance and appeals processes Coding practices Outpatient services MCG Inpatient rehabilitation National Guidelines Post-acute care +73

Exec Senior Full Time

USD 199K+

Senior Analyst, Dental Recruiter Fully Remote
Work At Home-Ohio

ADA codes Dental terminology Insurance Knowledge Managed Care Health care Medicare Recruitment Microsoft Excel Critical thinking +9

Senior Mid Full Time

USD 46K+

UM Nurse Consultant (Remote)
Work At Home-New York

Benefit management Benefit utilization Coverage determination Clinical Criteria Navigating multiple systems RN licensure Keyboarding Registered Nurse Clinical Judgment +15

USD 64K+

Diabetes Sales Associate- Trenton, NJ
United States of America : Remote

Interventional Pain Therapy Glucose Monitoring Informatics systems Nutrition Products Neuromodulation Quality System Heart failure Implantable devices Mobile technology +31

USD 57K+

Pharmacist - Medication Therapy Management (Work From Home)
Work At Home-Arizona

Pharmacist Medication therapy management Clinical assessment Pharmacy Managed Care Health care Medicare Assessment Clinical +12

USD 72K+

National Key Account Director
USA - Pennsylvania - North Wales (Upper Gwynedd)

B2B Market Knowledge Health outcomes Clinical proficiency Biologic Brand Strategy Operational Management Healthcare ecosystem Animal Health Products Distribution +47

Exec Senior Full Time

USD 181K+

Utilization Management Nurse Consultant
High Point-4050 Piedmont Parkway

Benefit utilization Benefit management Coverage determination RN licensure Clinical Criteria Telephonic Communication Medical necessity Telemetry Utilization Review +27

USD 52K+

Clinical Case Manager Behavioral Health
Work At Home-Kansas

Clinical Case Management Telephonic Outreach Community Resource Coordination Care Planning Utilization Review Discharge planning Clinical Practice Crisis Intervention Program development +19

USD 54K+

Behavioral Health Care Planner
Work At Home-Texas

Substance abuse Behavioral health care Social services Navigating multiple systems Member engagement Policies and procedures Keyboarding Psychology Managed Care +9

USD 42K+

Diabetes Sales Specialist -- Anaheim East
United States of America : Remote

Interventional Pain Therapy Glucose Monitoring Informatics systems Quality System Heart failure Nutrition Products Neuromodulation Implantable devices Mobile technology +32

USD 64K+

Medical Director - Florida
Remote US

Coding practices Health claims review Outpatient services Grievance and appeals processes MCG National Guidelines Inpatient rehabilitation Clinical Standards Post-acute care +74

Exec Senior Full Time

USD 199K+

Utilization Management Nurse Consultant
Work At Home-New York

Benefit management Benefit utilization Coverage determination RN licensure Clinical Criteria Acute care Telephonic Communication Keyboarding Medical necessity +21

USD 64K+

Senior Manager, Pharmacist, Formulary & Utilization Management Operations
Remote

Policy Review Formulary management Prior authorization Clinical Review Workforce management Technology Platform Utilization management Clinical operations Pharmacy +12

Senior Full Time

USD 158K+

Remote Jobs in North America Remote Jobs in Europe Remote Jobs in Asia/Pacific Remote Jobs in South America Remote Jobs in Africa Remote Jobs in Middle East Full Time Remote Jobs Part Time Remote Jobs Internship Remote Jobs Contract Remote Jobs Temporary Remote Jobs Freelance Remote Jobs Mid-Level Remote Jobs Senior-Level Remote Jobs Entry-Level Remote Jobs Exec-Level Remote Jobs Lead-Level Remote Jobs

Remote Jobs with CAD > 80K in Salary Remote Jobs with GBP > 80K in Salary Remote Jobs with EUR > 80K in Salary Remote Jobs with CAD > 100K in Salary Remote Jobs with CAD > 120K in Salary Remote Jobs with EUR > 100K in Salary Remote Jobs with GBP > 100K in Salary Remote Jobs with PHP > 80K in Salary Remote Jobs with PHP > 40K in Salary Remote Jobs with PHP > 120K in Salary Remote Jobs with PHP > 60K in Salary Remote Jobs with PHP > 100K in Salary Remote Jobs with PHP > 140K in Salary Remote Jobs with PHP > 160K in Salary Remote Jobs with PHP > 300K in Salary Remote Jobs with PHP > 240K in Salary Remote Jobs with PHP > 260K in Salary Remote Jobs with PHP > 280K in Salary Remote Jobs with PHP > 200K in Salary Remote Jobs with PHP > 220K in Salary