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Medical management Remote Jobs

72 fresh jobs found

Remote Behavioral Medical Director
Remote-IL, United States

Centene Corporation

Clinical practice improvement Health financing Provider network development Medical management programs Health care quality Health administration Personnel management Medical Review Clinical Quality +31

Exec Senior Full Time

USD 231K+

Vendor Performance Manager
Remote-FL, United States

Centene Corporation

Financial Responsibility Business solutions Procedures Medical management Effective Communication Care management Business administration Health Insurance Vendor Management +16

USD 68K+

Senior Behaviorial Health Program Manager
Remote-MI, United States

Centene Corporation

Managed care experience Corrective action plans Health management Clinical Criteria Workflow Design Provider education Psychology Health education Clinical Training +29

Senior Full Time

USD 86K+

Primary Nurse Case Admin I ONSITE - Dallas
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Wellness education Milliman guidelines Coordination of care Lotus Notes Medical Management Policies UM CM Database experience Condition Management +34

USD 60K+

Utilization Specialty OT Therapist Pediatric
Remote-TX, United States

Centene Corporation

Outpatient Therapy Services Clinical recommendations Evidenced Based Practice Pediatric care Authorization requests Operations support Documentation standards Network management +17

USD 118K+

Behavioral Health Clinical Liaison
Remote-FL, United States

Centene Corporation

Outpatient Treatment plans Substance use Substance abuse Provider education Clinical assessment Procedures Treatment Planning Health Services +28

USD 68K+

Clinical Review Nurse - Prior Authorization
Getzville-105 Crosspoint Pkwy (11106), United States

Centene Corporation

Clinical reviews Authorization requests Health management Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Acute care +18

USD 95K+

Infusion Care Coordinator
Remote-TX, United States

Centene Corporation

Client inquiries Hemophilia IVIG Pharmacy systems Care Plans Coverage determination Pharmacy Technician Triage Microsoft Suite +11

USD 64K+

Clinical Review Nurse - Concurrent Review
Remote-NY, United States

Centene Corporation

Health management Health management systems Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical Records +15

USD 52K+

Part-Time Weekend Medical Director
Remote-FL, United States

Centene Corporation

Health financing Government programs Medical management programs Provider network development Health administration Health care quality Personnel management Medical Review Clinical Quality +32

Exec Senior Part Time Full Time

USD 231K+

Supervisor, Utilization Management
Remote-NC, United States

Centene Corporation

Regulations knowledge UM Accreditation Standards Accreditation Clinical Review Procedures Health Services Prior authorization Medical management +17

USD 73K+

Pharmacy FWA Investigator I
Remote-FL, United States

Centene Corporation

Government programs Pharmacy fraud Corrective action plans Audit experience Claims analysis Pharmacy Technician Health Services Medical management Fraud Investigation +25

Entry Mid Full Time

USD 44K+

Bilingual Retention Representative
Remote-NY, United States

Centene Corporation

Health Services Medical management Effective Communication Database Management Databases Health Insurance Business Analysis Bilingual Access +13

USD 30K+

Pharmacy Technician (Appeals)
Remote-FL, United States

Centene Corporation

Formulary research Grievances Pharmacy operations Pharmacy Technician Appeals Medicare part d Prior authorization Health Services Medical management +10

Entry Mid Full Time

USD 38K+

Clinical Advisor
Work From Home (HB), United States

Health Care Service Corporation

Healthcare Management Healthcare Consulting Clinical Care Client Support Utilization Review Medical management Utilization management Consultative Quality Management +25

Senior Full Time

USD 66K+

Primary Nurse Case Admin l - TX
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Wellness education Lotus Notes Coordination of care Milliman guidelines Medical Management Policies UM CM Database experience Condition Management +33

USD 60K+

RN Clinical Review Nurse - Concurrent Review
Remote-CA, United States

Centene Corporation

Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical management Clinical knowledge Utilization management +9

USD 93K+

Autism Clinical Care Analyst
Remote-LA, United States

Centene Corporation

Autism spectrum disorder Insurance funding knowledge Behavioral support planning Treatment plan evaluation Applied Behavior Analysis Treatment plans Behavioral Analysis Clinical assessment Health Services +8

Entry Mid Full Time

USD 68K+

TeleHealth Registered Nurse (Registry)
Remote-TX, United States

Centene Corporation

Health management Care Planning Triage Home Health Patient Assessment Procedures Health Services Medical management Clinical knowledge +10

USD 95K+

(RN) Oncology Nurse Case Management Lead Analyst -Evernorth Health Services - Remote
Pennsylvania Work at Home, United States

The Cigna Group

Shared Decision Making Oncology nursing Disease Prevention Nurse Case Management Digital Messaging Health promotion Behavior Change Internet Research Telephonic Communication +32

Senior Mid Full Time

USD 76K+

Senior Director, Utilization Management
Remote-MO, United States

Centene Corporation

Ncqa standards Healthcare Management Procedures Health Services Medical management Utilization management Policy Development RN Health Insurance +15

Senior Full Time

USD 157K+

Pharmacy Technician I
Remote-MI, United States

Centene Corporation

Client inquiries Pbm system Specialty drugs Prior authorizations Coverage determination Pharmacy Technician Triage Health Services Medical management +6

Entry Mid Full Time

USD 53K+

Pharmacy Operations Coordinator I-4
Remote-CA, United States

Centene Corporation

Formulary setup Program Coordination Claims analysis Pharmacy operations Pharmacy Technician Health Services Medical management Claims Health Insurance +7

USD 64K+

Authorization Specialist II
Remote-MS, United States

Centene Corporation

Healthcare eligibility Authorization processes Authorization requests Insurance coverage Referrals Procedures Health Services Prior authorization Medical management +10

Entry Mid Full Time

USD 55K+

Autism Service Navigator
Remote-LA, United States

Centene Corporation

Health instruction Goal development Autism spectrum disorder Medical referrals Behavioral health services Pediatrics Clinical assessment Psychology Referrals +15

USD 68K+

Senior Director, Utilization Management
Remote-NY, United States

Centene Corporation

Ncqa standards Healthcare Management Procedures Health Services Medical management Utilization management Policy Development RN Health Insurance +15

Senior Full Time

USD 157K+

Litigation Consultant
Recruiting Only - Telecommuter, United States

Legal pleadings Social Security Insurance principles Cost Containment Liability Interpretive Performance competencies Discovery PC literate +25

Senior Mid Full Time

USD 75K+

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+

Clinical Review Clinician - Appeals
Remote-NY, United States

Centene Corporation

Clinical reviews Appeals processing Clinical data analysis Interdepartmental Collaboration Ncqa standards Medicaid regulations Appeals Clinical Review Medical necessity +19

USD 52K+

Clinical Pharmacist (MTM Support) Bilingual Spanish
Remote-FL, United States

Centene Corporation

Telephonic Medication Reviews Drug Therapy Optimization Patient Profile Review Multidisciplinary Team Collaboration Drug therapy Pharmacy Software Medication therapy management Clinical pharmacy Health Services +9

USD 105K+

Deputy Assistant Director
REMOTE OPTIONS, PHOENIX

State of Arizona

Medicaid programs Quality outcomes Programmatic decisions Procurement initiatives Policy decisions Clinical Initiatives Managed care operations Administrative hearings Quality of care +57

Exec Senior Full Time

USD 110K+

Clinical Review Nurse - Prior Authorization
Remote-NY, United States

Centene Corporation

Clinical reviews Authorization requests Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Prior authorization Health Services +15

USD 52K+

Primary Nurse Case Admin I - TX
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Wellness education Milliman guidelines Coordination of care Lotus Notes Medical Management Policies UM CM Database experience Condition Management +34

USD 60K+

Utilization Review Clinician - Behavioral Health
Remote-FL, United States

Centene Corporation

Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Provider education Clinical Review Utilization Review Discharge planning Treatment Planning +18

USD 52K+

Pharmacy Operations Specialist I
Remote-CA, United States

Centene Corporation

Quality process improvement UAT Pharmacy operations Health Services Medical management Health Insurance Managed Care Medicare Medicaid +8

USD 47K+

Manager, Autism Clinical Care
Remote-LA, United States

Centene Corporation

Functional behavioral analysis Behavioral services Quality of care Medical Review Behavioral Analysis Accreditation Claims resolution Clinical Oversight Provider Relations +21

USD 86K+

Authorization Specialist IV
Remote-MO, United States

Centene Corporation

Authorization process Healthcare eligibility Payment reviews Authorization processes Authorization requests Insurance coverage Referrals Prior authorization Health Services +13

USD 76K+

Remote Medical Director - Michigan
Remote-MI, United States

Centene Corporation

Clinical practice improvement Health financing Provider network development Medical management programs Health care quality Health administration Personnel management Medical Review Clinical Quality +31

Exec Senior Full Time

USD 221K+

Utilization Review Clinician - Behavioral Health
Remote-MO, United States

Centene Corporation

Education provision Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Utilization Review Discharge planning Health Services +17

USD 52K+

RN Case Manager- NICU- Remote
Pennsylvania Work at Home, United States

The Cigna Group

Shared Decision Making Disease Prevention Digital Messaging Health promotion Behavior Change Internet Research Cultural Sensitivity Clinical Acumen Motivational interviewing +28

USD 76K+

Pharmacy Operations Coordinator I
Remote-AZ, United States

Centene Corporation

Formulary setup Claims analysis Pharmacy operations Health Services Medical management Claims Health Insurance Managed Care Testing +5

USD 64K+

Wellbeing Health Advisor - OK
Tulsa Oklahoma HQ (1400 S. Boston Avenue), United States

Health Care Service Corporation

Medical Management Policies Milliman guidelines Database experience Condition Management PC Proficiency Clinical Care PC Clinical Practice Clinical Judgment +22

USD 60K+

(RN) Nurse Case Management Lead Analyst - Evernorth Health Services -Remote
Pennsylvania Work at Home, United States

The Cigna Group

Shared Decision Making Disease Prevention Nurse Case Management Digital Messaging Health promotion Behavior Change Internet Research Telephonic Communication Cultural Sensitivity +28

Senior Mid Full Time

USD 76K+

RN-Oncology Nurse Case Manager- Remote
Arizona Work at Home, United States

The Cigna Group

Shared Decision Making Disease Prevention Digital Messaging Health promotion Behavior Change Internet Research Telephonic Communication Clinical Acumen Motivational interviewing +26

USD 76K+

Medicare Grievances and Appeals Corporate Medical Director
Remote US, United States

Rehab Health claims review Hospitalist Medical background Medical interpretation Family practice Geriatrics Medical Director Patient interaction +42

Exec Senior Full Time

USD 246K+

Medical Only Adjuster
Florida, US | Home Based, US

Davies North America Remote-first

Workers’ Compensation Law Independent Claims investigation Proactive Workers Compensation Subrogation Medical management COM Litigation +24

USD 44K+

Medical Director - New Hampshire
Remote-NH, United States

Centene Corporation

Health financing Provider network development Medical management programs Health administration Health care quality Personnel management Medical Review Medical Services Accreditation Standards +27

Exec Senior Full Time

USD 206K+

Retention Field Representative - Brooklyn (Cantonese, Mandarin)
Remote-NY, United States

Centene Corporation

Facets Cantonese Home visits Mandarin Medical management Health Services Health Insurance Databases Regulatory +13

Entry Mid Full Time

USD 44K+

Medical Director - Acute Rehab Team
Remote US, United States

Rehab Inpatient rehabilitation Medical background Hospitalist Clinical reference materials Medical interpretation CMS policies Family practice National Guidelines +55

Exec Senior Full Time

USD 223K+

Medical Director, Behavioral Health (Part Time, Remote), Licensed/Reside in CA
Remote CA San Diego 92105, United States

Magellan Health Remote-first

Medical Necessity Guidelines Interdisciplinary Team Collaboration Accreditation Standards Peer review Clinical Leadership Medical management Quality improvement Utilization management Policy Development +2

Exec Senior Part Time

USD 200K+

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