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17 fresh jobs found

Case Manager- Out of Network Management- System Services- Remote -Full Time- Days
System Services-Telecommuter, United States

Sharp HealthCare

Health plan criteria MCG Clinical Nursing Healthcare Coordination InterQual Patient Assessment Utilization Review Utilization management Consultation +6

USD 60K+

Behavioral Health 24/7 Clinical Navigation and Support Care Manager - Evernorth Health Services - Remote
Minnesota Work at Home, United States

The Cigna Group

Confidentiality regulations Telephonic consultation Biopsychosocial assessment Brief therapy Employee assistance programs Solution focused therapy MCG De-escalation Clinical Judgment +32

Senior Mid Full Time

USD 65K+

Medical Director - Gulf South
Remote US, United States

Post-acute services Grievance and appeals processes Community Groups Outpatient services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +88

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Community Groups Outpatient services Grievance and appeals processes Inpatient rehabilitation Commercial health insurance Clinical group practice management Post-acute care Humana policies +83

Exec Senior Full Time

USD 223K+

Behavioral Health Medical Director - Medicaid
Remote US, United States

Computer-Based Review CGX Community Groups Clinical reference materials CMS policies Medical background MCG Medical Director Clinical evaluation +48

Exec Senior Full Time

USD 223K+

Medical Director- South Central
Remote US, United States

Community Groups Outpatient services Grievance and appeals processes Post-acute services Clinical group practice management Inpatient rehabilitation Post-acute care Commercial health insurance Humana policies +86

Exec Senior Full Time

USD 223K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

Telephonic Nurse Case Manager
HGB SCA Remote PA, United States

Holistic approach Tricare MCG Evidence-based medicine Clinical Nursing Medical Services Accreditation Motivational interviewing Utilization Review +45

USD 71K+

Medical Director - Northeast Region
Remote US, United States

Community Groups Outpatient services Post-acute services Grievance and appeals processes Clinical group practice management Commercial health insurance Post-acute care Inpatient rehabilitation CMS policies +88

Exec Senior Full Time

USD 223K+

Medical Director - Southeast Region
Remote US, United States

Health claims review Community Groups Outpatient services Post-acute services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Humana policies +84

Exec Senior Full Time

USD 223K+

Medical Director - South Central
Remote US, United States

Community Groups Grievance and appeals processes Outpatient services Post-acute services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Social determinants +85

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Clinical guidelines knowledge Managed Care Knowledge Medicare Knowledge Commercial health insurance Clinical group practice management Inpatient rehabilitation Clinical Decision Making Social determinants Grievance and appeals +78

Exec Senior Full Time

USD 223K+

Utilization Management Nurse (Gulf South Region)
Work at Home - Louisiana, United States

Milliman Interpreting Criteria Health Plan Experience MCG Clinical Nursing Medical Services Acute care Consumer Experiences Discharge planning +46

USD 71K+

Utilization Management Nurse
Work at Home - Florida, United States

CGX Interpreting Criteria MCG Clinical Nursing Medical Services Registered Nurse Clinical knowledge Utilization management BI +38

USD 71K+

Medical Director- South Central
Remote US, United States

Post-acute services Clinical group practice management Commercial health insurance Outpatient services Grievance and appeals processes Clinical Decision Making Post-acute care Inpatient rehabilitation Social determinants +83

Exec Senior Full Time

USD 223K+

Medical Director (Clinical Chart Validation Team)
Remote, United States

Decision support software Chart validation Provider Billing Milliman DRG ICD-9 Coding accuracy MCG InterQual +32

Exec Senior Full Time

USD 190K+

Medical Director - Southeast Region
Remote US, United States

Post-acute services Outpatient services Grievance and appeals processes Clinical group practice management Inpatient rehabilitation Commercial health insurance Coding practices Medical background Hospitalist +82

Exec Senior Full Time

USD 223K+

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