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Medical management Remote Jobs

94 fresh jobs found

Prior Authorization LVN Nurse - Remote
United States

Tenet Healthcare

EZ-CAP Medical management documentation system LVN Healthcare industry expertise ICD-9 CPT coding Acute care Utilization Review Medical management +24

USD 81K+

Medical Director - Florida
Remote US, United States

Clinical patient care Health claims Managed Care Knowledge Post-acute services Home health services Family practice Inpatient rehabilitation Hospitalist National Guidelines +73

Exec Senior Full Time

USD 223K+

Claims Specialist Sr - Professional Liability
Telecommuter NY, United States

Settlement strategies Legal defense Injury claims Medical malpractice Vendor partnerships Strategic vendor partnerships Social Security Insurance principles Claims coding +40

Senior Full Time

USD 110K+

Worker's Compensation Claims Examiner
Telecommuter GA, United States

Strategic vendor partnerships Vendor partnerships Insurance principles Social Security Claims coding Vendor Coordination Claims analysis Cost Containment Litigation management +36

Senior Mid Full Time

USD 61K+

Senior Pharmacy Resolution Specialist
Remote-MI, United States

Centene Corporation

Pharmacy retail Authorization requests Audit Preparation Pharmacy operations Pharmacy Technician Data gathering Guidelines Prior authorization Medical management +18

Senior Mid Full Time

USD 64K+

Medical Director--Claims Management
Remote US, United States

Inpatient care Clinical patient care Computer-Based Review Outpatient services Home health services Grievance and appeals processes Clinical reference materials CMS policies Post-acute care +87

Exec Senior Full Time

USD 223K+

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

Centene Corporation

Cantonese Home visits Mandarin Facets Researching Medical management Health Services Network Health care +21

Entry Mid Full Time

USD 44K+

Program Manager
Remote-AZ, United States

Centene Corporation

Quality process improvement Healthcare Reporting Analysis Tools Data Aggregation Training materials Staff training Healthcare Management Program Design Independent Judgment +33

USD 68K+

Director, Utilization Management
Remote-OH, United States

Centene Corporation

Ncqa standards Provider experience Healthcare Management NCQA Utilization Medical management Performance Improvement Health Services Training and Development +27

Exec Senior Full Time

USD 124K+

Medical Policy Analyst
Remote-MO, United States

Centene Corporation

Medical literature research Abuse management Medical policy development Clinical Practice Guidelines Technology assessments Waste management Evidence-based medicine Fraud Management Payment Integrity +18

Entry Mid Full Time

USD 68K+

Pharmacy Coordinator
Remote-IN, United States

Centene Corporation

Formulary process Prior authorizations Grievances Employee Training Pharmacy Technician Provider Relations Utilization Health Plan Utilization Review +21

USD 64K+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Clinical Information Clinical Review +25

Senior Mid Full Time

USD 60K+

RN Clinical Review Clinician_Appeals
Remote-CA, United States

Centene Corporation

Appeals processes Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations Researching NCQA Clinical Review Guidelines +27

USD 95K+

Behavioral Analyst, BCBA
Remote-TX, United States

Centene Corporation

Applied Behavioral Analysis Behavioral Analysis Managed care experience HIPAA regulations Community outreach Medical management Health Services HIPAA Compliance Procedures +15

Entry Mid Full Time

USD 55K+

Supervisor, Appeals Grievance
Remote-MO, United States

Centene Corporation

Appeals management Grievance Grievance resolution Grievances Performance Evaluation Appeals Health Plan Counseling Trend Analysis +26

USD 55K+

Public Programs Specialist
Remote-CA, United States

Centene Corporation

Member access Provider network management Clinical Management Grievances Healthcare Collaboration Health care services Service coordination Pharmacy Technician Medical Review +25

Entry Mid Full Time

USD 77K+

Supervisor, Clinical Grievance and Appeals
Remote-MO, United States

Centene Corporation

Appeals management Grievance Grievances Ncqa standards Quality Metrics NCQA Regulatory reporting Medical necessity Appeals +31

USD 68K+

UM Coordinator
Work From Home (HB), United States

Health Care Service Corporation

Medical claims review Ancillary services UM Medical Necessity Review Medical claims Healthcare Management Report Preparation Medical necessity Registered Nurse +20

USD 56K+

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

Centene Corporation

Patient Profile Review Drug Therapy Optimization Multidisciplinary Team Collaboration Drug therapy Software management Medication therapy management Clinical pharmacy Telephonic Communication Medical management +13

USD 105K+

Pre-Authorization Registered Nurse
Remote US, United States

Medical management systems Rehab Medicaid Experience Health Plan Experience Microsoft Office Word Clinical Nursing InterQual MCG Rehabilitation +53

USD 71K+

Customer Service Representative 4
REMOTE OPTIONS, PHOENIX

State of Arizona

Eligibility Criteria Medical eligibility Interviewing techniques Medicaid programs Billing practices CMS guidelines Provider Enrollment Database Applications AMS +45

Entry Mid Full Time

USD 38K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Medical necessity Clinical Review Discharge planning Utilization Acute care +20

USD 95K+

Authorization Specialist II
Remote-FL, United States

Centene Corporation

Healthcare eligibility Healthcare Policies Authorization processes Authorization requests Insurance coverage Researching Guidelines Adjudication Utilization +19

Entry Mid Full Time

USD 55K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Culturally diverse care Medical management programs Health care quality Health financing Provider network development Government programs Clinical quality improvement Health administration Accreditation Standards +41

Exec Senior Full Time

USD 231K+

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

The Cigna Group

Shared decision making Disease prevention Oncology nursing Digital Messaging Cigna Telephonic Communication Health promotion Cultural Sensitivity Behavior Change +33

Senior Mid Full Time

USD 76K+

Sr. Claims Specialist, Medical Malpractice (Professional Liability)
Telecommuter NY, United States

Legal defense Injury claims Settlement strategies Medical malpractice Strategic vendor partnerships Vendor partnerships Recovery Social Security Insurance principles +38

Senior Full Time

USD 100K+

Intake Representative I
Remote-FL, United States

Centene Corporation

Authorization Systems Clinical Information Tracking Medical management Quality Standards Health Services Claims processing Claims Call Center +15

Entry Full Time

USD 53K+

TeleHealth Registered Nurse - Registry
Remote-TX, United States

Centene Corporation

Obstetrics Health management Patient Assessment Guidelines Care Planning Clinical Information Home Health Triage Medical management +16

USD 95K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Clinical Review Medical necessity Discharge planning Utilization Acute care +20

USD 95K+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Guidelines Clinical Information +23

USD 95K+

Supervisor, Behavioral Health Utilization Management
Remote-FL, United States

Centene Corporation

Regulations Compliance UM Guidelines Accreditation Standards Clinical Supervision Medical necessity Utilization Accreditation Utilization Review +28

USD 73K+

Senior Manager, Claims Configuration Operations
Remote-MO, United States

Centene Corporation

Claims Configuration Data Sources Medical management Quality Standards Health Services Operations Management Quality improvement Claims Business strategy +23

Senior Full Time

USD 105K+

Grievance & Appeals Coordinator I
Remote-NY, United States

Centene Corporation

Grievance Claims research Grievance resolution Grievances Managed care experience Researching HEDIS Organizing Appeals +17

Entry Mid Full Time

USD 64K+

Housing Management Specialist II
Remote-NV, United States

Centene Corporation

Housing management Permanent supportive housing Transitional housing programs Fair housing Client assessment Eligibility Determination Housing regulations Community collaboration Continuum of care +35

USD 55K+

Medical Director - National Medicare Team
Remote US, United States

Healthcare provider management Medicaid Experience Managed Care Knowledge NCD LCD Humana policies Medical interpretation National Guidelines Clinical group practice management +49

Exec Senior Full Time

USD 223K+

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

Centene Corporation

TruCare Health management systems InterQual Guidelines Health management Medicaid regulations Clinical Review Medical necessity Discharge planning +22

USD 52K+

Grievance & Appeals Coordinator I
Remote-AZ, United States

Centene Corporation

Grievance Claims research Grievances Managed care experience Researching Claims resolution Organizing Appeals Tracking +16

USD 38K+

Director, Business Operations
Remote-MO, United States

Centene Corporation

Guidelines Healthcare operations Lean Six Sigma Contact center Medical management PMP Healthcare experience Digital technology Operations Management +33

Exec Senior Full Time

USD 116K+

Clinical Review Nurse - Prior Authorization (RN)
Remote-CA, United States

Centene Corporation

RN licensure Service authorization Medical appropriateness Authorization requests Guidelines Clinical reviews Health management systems Medicaid regulations Health management +24

USD 95K+

Authorization Specialist I
Remote-TX, United States

Centene Corporation

Healthcare eligibility Authorization processes Authorization requests Guidelines Utilization Tracking Prior authorization Medical management Referrals +15

Entry Full Time

USD 45K+

Member Experience Specialist
Remote-FL, United States

Centene Corporation

Member Experience Contact center Communication Strategies Medical management Health Services Call Center Data Entry Health Insurance Metrics +15

USD 64K+

Medical Director - Medicaid N. Central
Remote US, United States

Health claims review Computer-Based Review Post-acute services Grievance and appeals processes Post-acute care Humana policies Family practice Clinical group practice management Medical interpretation +92

Exec Senior Full Time

USD 223K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

ABA services Autism spectrum disorder Guidelines Medical appropriateness Behavioral Analysis Healthcare Provider Interaction Clinical Standards Applied Behavior Analysis Treatment plans +29

USD 95K+

Authorization Specialist II
Remote-MO, United States

Centene Corporation

Healthcare eligibility Authorization processes Guidelines Authorization requests Insurance coverage Researching Adjudication Insurance Knowledge Utilization +19

Entry Mid Full Time

USD 55K+

Senior Vendor Business Technical Analyst
Remote-MO, United States

Centene Corporation

Database Solutions VB.NET Corrective Actions System Analysis HEDIS ASP.NET Medical management Issue Resolution Health Services +28

Senior Mid Full Time

USD 86K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Claims review Health financing Medical management programs Provider network development Health care quality Government programs Clinical quality improvement Health administration Personnel management +40

Exec Mid Full Time

USD 231K+

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

Centene Corporation

Guidelines Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Utilization Review +21

USD 52K+

Pharmacy FWA Investigator I
Remote-FL, United States

Centene Corporation

Pharmacy fraud Audit experience Retail Pharmacy Data Sources Pharmacy Technician Corrective action plans Government programs Claims analysis Health Plan +32

Entry Mid Full Time

USD 44K+

Litigation Liability Consultant | Bodily Injury Experience Required!
Eden Prairie, MN - Prairie Lakes, United States

Legal pleadings Social Security Insurance principles Liability Cost Containment Interpretive Bodily injury Performance competencies PC literate +26

Senior Mid Full Time

USD 90K+

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

Centene Corporation

Education provision Outpatient Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Utilization Clinical Review Discharge planning +23

USD 52K+

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