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Medical management Remote Jobs

40 fresh jobs found
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Pharmacy Operations Specialist I
Remote-FL, United States

Centene Corporation

Pharmacy Claims Processing Quality process improvement Pharmacy operations Training materials Pharmacy Claims Pharmacy Technician UAT Medicare part d Power Automate +30

USD 44K+

Program Manager II - Medical Management
Remote-CA, United States

Centene Corporation

Mental Health Parity Managed care experience UM Business process documentation Compliance Documentation Compliance requirements Project Implementation Business Process Medical management +35

USD 68K+

Claims Adjuster - Workers Compensation - Telecommute CO
Telecommuter CO, United States

Social Security Claims coding Action plans Interpretive Adjudication Keyboarding PC literate Microsoft Office products Medical management +24

USD 60K+

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

Centene Corporation

Medical appropriateness Healthcare Collaboration Treatment plans Clinical Review Utilization Guidelines Regulatory Guidelines Discharge planning Medical management +22

USD 52K+

Grievance & Appeals Coordinator I
Remote-AZ, United States

Centene Corporation

Claims research Grievance resolution Managed care experience Grievances Researching HEDIS Organizing Appeals Medical management +16

Entry Mid Full Time

USD 64K+

EPSDT Coordinator
Remote-IL, United States

Centene Corporation

Improvement plans Performance goals Pediatric care Community relations Ncqa standards NCQA Health Plan Health Services Medical management +16

Entry Mid Full Time

USD 44K+

Psychologist Reviewer
Remote-AZ, United States

Centene Corporation

Diagnostic evaluations Psychological testing Clinical Information Behavior Analysis Utilization Psychology Medical necessity Health Services Substance abuse +17

USD 86K+

Sr. Claims Specialist, Medical Malpractice (LTC)
Recruiting Only - Telecommuter, United States

Legal defense Social Security Strategic vendor partnerships Medical malpractice Settlement strategies Injury claims Vendor partnerships Insurance principles Claims coding +36

Senior Full Time

USD 100K+

Bilingual Disability Case Manager
CA-ON-Ontario-Virtual, Canada

Alight Solutions

HR Communication Occupational Interventions Disability Case Management Return to Work Strategies Rehabilitation Absence Management Medical management Sanctions Flexible Working +16

CAD 40K+

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

Centene Corporation

UM Accreditation Standards Compliance monitoring Utilization Guidelines Medical necessity Clinical Supervision Performance Evaluation Medical management +31

USD 73K+

Pharmacy Resolution Specialist
Remote-FL, United States

Centene Corporation

Pharmacy benefits CMS regulations Outbound Calls Claims resolution Guidelines Inbound Calls Medical management Health Services Prior authorization +16

Entry Full Time

USD 30K+

Clinical Appeals Coordinator
Remote-AR, United States

Centene Corporation

Appeals coordination Ncqa compliance Ncqa standards Clinical Nursing Clinical Information Utilization NCQA Medical necessity Medical management +17

USD 66K+

Accreditation Specialist II
Remote-FL, United States

Centene Corporation

Continuous quality improvement Process Implementation Accreditation Standards HEDIS NCQA Medical management Health Services Tracking Accreditation +24

USD 68K+

Remote Medical Director - California
Remote-CA, United States

Centene Corporation

Adverse trend evaluation Medical Necessity Review Health financing Medical management programs Provider network development Health care quality Clinical quality improvement Health administration Government programs +44

Exec Senior Full Time

USD 231K+

RN Clinical Review Clinician - Appeals
Remote-CA, United States

Centene Corporation

Medical Records Review Interdepartmental Collaboration Case reviews UM Ncqa standards Medicaid regulations Clinical reviews Researching Clinical Review +30

USD 52K+

Claims Adjuster, Workers Compensation
United States

Claim adjudication Litigation management Medical management Collaboration Tools Commercial Insurance G Suite Workers Compensation Claims management Slack +8

USD 70K+

Autism Service Navigator
Remote-LA, United States

Centene Corporation

Health instruction Complex care coordination Autism spectrum disorder ABA services Intervention Planning Pediatrics ABA Psychology Health Services +22

USD 68K+

Pharmacy Operations Specialist I
Remote-TX, United States

Centene Corporation

Quality process improvement Training material creation Pharmacy operations Pharmacy Technician UAT Training materials Health Services Medical management User Acceptance Testing +18

USD 77K+

Utilization Review/Appeals Clinician - ABA
Remote-FL, United States

Centene Corporation

ABA services Autism spectrum disorder Medical appropriateness Clinical Standards Applied Behavioral Analysis Behavioral Analysis Healthcare Provider Interaction Applied Behavior Analysis Treatment plans +28

USD 52K+

Medical Director - Home Health - OneHome/Home Solutions
Remote US, United States

CMS Medicare Collaborative relationships LCD NCD Inpatient care Clinical patient care Team culture CMS policies Clinical reference materials +50

Exec Senior Full Time

USD 223K+

Personal Health Nurse - Remote
United States

Tenet Healthcare

Clinical analysis Personal health management Email proficiency Care Plan Development Cost Containment Medical management Healthcare industry expertise Utilization Review Utilization management +21

USD 64K+

Claims Clinical Documentation Reviewer
REMOTE OPTIONS, PHOENIX

State of Arizona

Healthcare laws Prepayment claims review Medical necessity evaluation Audit reporting Service planning Claims review Medicaid programs Stakeholder Coordination Documentation Review +61

USD 68K+

Medical Director
Remote-IL, United States

Centene Corporation

Health financing Health care quality Medical management programs Substance Use Disorders Provider network development Clinical quality improvement Government programs Clinical Quality Substance use +45

Exec Senior Full Time

USD 221K+

PASRR Program Supervisor
REMOTE OPTIONS, PHOENIX

State of Arizona

Program improvement Heaplus Federal and state laws Medicaid programs Program Planning State laws Policies and procedures Reviewing Arizona Administrative Code +59

USD 62K+

Claims Examiner - Workers Compensation - Telecommute CO
Telecommuter CO, United States

Strategic vendor partnerships Vendor partnerships Social Security Insurance principles Claims coding Vendor Coordination Cost Containment Litigation management Rehabilitation +34

Senior Mid Full Time

USD 65K+

Pharmacy Operations Coordinator I
Remote-AZ, United States

Centene Corporation

Formulary setup Pharmacy operations Claims analysis Pharmacy Technician Program development Medical management Health Services Claims Coordination +13

USD 64K+

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+

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+

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+

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+

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 Marketplace Medical Director
Remote-MO, United States

Centene Corporation

Claims review Medical management programs Provider network development Government programs Health care quality Health financing Clinical quality improvement Personnel management Health administration +39

Exec Mid Full Time

USD 231K+

Medical Director - Care Plus
Remote US, United States

Grievance processes Health claims review Outpatient services Grievance and appeals processes Post-acute care Clinical group practice management Commercial health insurance Hospitalist Inpatient rehabilitation +90

Exec Senior Full Time

USD 223K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Outpatient services Grievance and appeals processes Post-acute care Humana policies Hospitalist Medical interpretation National Guidelines Family practice +83

Exec Mid Full Time

USD 223K+

Vice President, Population Health - Care Management
Remote-MO, United States

Centene Corporation

Consumer assessment URAC CAHPS Member engagement HEDIS NCQA Health Plan Population health Medical management +28

USD 182K+

Medical Director
Remote-OH, United States

Centene Corporation

Substance Use Disorders Medical management programs Clinical quality improvement Health care quality Utilization Provider network development Government programs Health financing Accreditation Standards +45

Exec Senior Full Time

USD 221K+

Remote Medical Director - South Carolina
Remote-SC, United States

Centene Corporation

Utilization Medical management programs Clinical quality improvement Health care quality Government programs Provider network development Health financing Personnel management Accreditation Standards +39

Exec Mid Full Time

USD 221K+

Medical leadership support Implementer
Amsterdam

Artsen zonder Grenzen Nederland

Hybrid methods Remote methods Field consultancy Stakeholder Coordination Medical management Training Development Public health Mentoring Coaching +1

Senior Mid Full Time

EUR 55K+

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