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Medical management Remote Jobs

121 fresh jobs found

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+

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

Centene Corporation

Health management systems Medicaid regulations Health management Utilization Clinical Review Medical necessity Acute care Discharge planning Medical Records +19

USD 52K+

Senior Business Technical Analyst - SAS/Python
Remote-FL, United States

Centene Corporation

Database Solutions Corrective Actions System Analysis Data Extraction Adjudication Medical management Issue Resolution Financial Health Services +29

Senior Mid Full Time

USD 86K+

Member Relationship Liaison
Remote-MO, United States

Centene Corporation

Telephonic Education Provider outreach Provider experience Client satisfaction Health Plan CMS Medical management Health Services Problem Resolution +18

USD 55K+

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

Centene Corporation

Pharmacy Software Patient Profile Review Multidisciplinary Team Collaboration Drug Therapy Optimization Telephonic Medication Reviews Drug therapy Medication therapy management Clinical pharmacy Medical management +12

USD 105K+

Behavioral Health Service Mgr-BH Medication Monitoring
Remote-OK, United States

Centene Corporation

Behavioral health services Mental health resources Utilization Data Monitoring Clinical Nursing Quality of care Foster care Evidence-based practices Discharge planning +32

USD 95K+

Authorization Specialist I
Remote-NY, United States

Centene Corporation

Authorization processes Healthcare eligibility Utilization Authorization requests Prior authorization Referrals Medical management Health Services Utilization management +13

Entry Full Time

USD 45K+

Lead Grievance & Appeals Coordinator
Remote-CA, United States

Centene Corporation

Grievance Management Appeals processing Grievance Ncqa standards NCQA Compliance monitoring Report Preparation Health Plan Appeals +21

Senior Mid Full Time

USD 44K+

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+

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

Centene Corporation

Utilization Health management systems Medicaid regulations Health management Medical necessity Clinical Review Acute care Discharge planning Medical Records +19

USD 95K+

Remote Child / Adolescent Medical Director - Florida
Remote-FL, United States

Centene Corporation

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

Exec Senior Full Time

USD 231K+

Holistic Health Specialist
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Intensive Care Medicine Orthopedic Maternity Management Diabetic Management Pediatric NICU Milliman guidelines Medical Management Policies Database experience +35

USD 60K+

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

Centene Corporation

Utilization Medicare regulations Cost-effective care Service authorization Health management systems Medicaid regulations Health management Authorization requests Medical appropriateness +26

USD 52K+

Appeals Specialist II
Remote-TX, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Mid Full Time

USD 40K+

Remote PRN Medical Director - Missouri
Remote-MO, United States

Centene Corporation

Clinical quality improvement Pediatrics Health financing Clinical programs Personnel management Clinical Quality Medical Review Health administration Medical Services +24

Exec Mid Part Time

USD 212K+

Grievance & Appeals Coordinator I
Burr Ridge - 1333 Burr Ridge Pkwy, Ste 125 (10938), United States

Centene Corporation

Claims research Utilization Grievance Grievances Managed care experience HEDIS Appeals Medical management Health Services +14

Entry Mid Full Time

USD 64K+

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+

Quality of Care Coordinator
Remote-KS, United States

Centene Corporation

Quality of care assessment Organizational policy adherence Clinical criteria application Clinical Criteria Medical Records Review Cphq Peer review Quality of care Medical Records +18

USD 118K+

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+

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+

Maternity Clinical Practice Advisor
Remote-NV, United States

Centene Corporation

Maternal care Utilization metrics Clinical Practice Guidelines RN licensure Community partnerships Clinical Initiatives Quality performance Billing practices Clinical Standards +43

USD 68K+

Remote Beahvioral Medical Director - Kentucky
Remote-KY, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Health care quality Medical management programs Health financing Provider network development Government programs Clinical Quality Medical Review +39

Exec Mid Full Time

USD 231K+

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

Health Care Service Corporation

CM Medical Management Policies Standardized Criteria Milliman guidelines Database experience Ancillary services Condition Management UM Coordination of care +35

USD 60K+

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

Centene Corporation

Healthcare Collaboration Medical appropriateness Substance abuse Treatment plans Provider education Discharge planning Clinical Review Utilization Review Treatment Planning +21

USD 52K+

Psychologist Reviewer
Remote-SC, United States

Centene Corporation

Education on best practices Diagnostic evaluations Outpatient Psychological testing Peer reviews Substance abuse Clinical Information Clinical Psychology Psychology +18

USD 84K+

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

Centene Corporation

RN licensure Health management systems UM Medicaid regulations Health management InterQual Acute care Discharge planning Clinical Review +22

USD 52K+

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+

Senior Pharmacy Resolution Specialist
Remote-MI, United States

Centene Corporation

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

Senior Mid Full Time

USD 64K+

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

Centene Corporation

Medical appropriateness Healthcare Collaboration Substance abuse Treatment plans Discharge planning Clinical Review Utilization Review Prior authorization Medical management +20

USD 52K+

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

Centene Corporation

Service authorization Health management systems Health management Medicaid regulations Authorization requests Medical appropriateness Clinical reviews Clinical Information Clinical Review +21

USD 95K+

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

Centene Corporation

Claims Configuration Quality Standards Medical management Health Services Quality improvement Claims Business administration Business strategy Managed Care +21

Senior Full Time

USD 105K+

Grievance & Appeals Coordinator II
Remote-PA, United States

Centene Corporation

Grievance Grievance resolution Grievances Claims analysis Medical Review Appeals Medical management Health Services Procedures +17

USD 44K+

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

Centene Corporation

Education provision Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Prior authorization +20

USD 52K+

Registered Nurse RN Medical Management Services
Remote Phoenix AZ, United States

Primary Care Registered Nurse Prior authorization Medical management Care Coordination Utilization management Regulations Nursing Case Management +5

USD 112K+

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+

Opioid Case Management Lead Analyst - Evernorth Health Services - Remote
Ohio Work at Home, United States

The Cigna Group

Pain management Cognitive behavioral coaching Telephonic counseling Telephonic support Health care services Treatment plans Health education Substance Use Disorder Goal setting +29

Senior Mid Full Time

USD 65K+

Authorization Specialist I
Remote-MO, United States

Centene Corporation

Authorization processes Healthcare eligibility Authorization requests Prior authorization Medical management Referrals Health Services Procedures Utilization management +12

Entry Full Time

USD 45K+

Medication Therapy Management Clinical Pharmacist
Remote-FL, United States

Centene Corporation

Patient profile evaluation Software management Telephonic Medication Reviews Drug Therapy Optimization Drug therapy Multidisciplinary teamwork Medication therapy management Clinical pharmacy Medical management +12

USD 105K+

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

Centene Corporation

Service authorization Medical necessity analysis Medicare regulations Health management systems Medical appropriateness Health management Clinical reviews Authorization requests Medicaid regulations +22

USD 95K+

Medical Policy Analyst
Remote-MO, United States

Centene Corporation

Medical literature research Health care management Technology assessments Clinical Practice Guidelines Evidence-based medicine Medical policy Acute care Medical management Health Services +14

Entry Mid Full Time

USD 68K+

VP, PHCO Utilization Management Medicaid & Marketplace
Remote-MO, United States

Centene Corporation

Ncqa standards NCQA Clinical Training Financial Forecasting Provider Relations Acute care Marketplace Reconciliation Utilization Review +25

Exec Senior Full Time

USD 182K+

Manager, Clinical Pharmacy Operations (Medicare Part D)
Remote-TX, United States

Centene Corporation

Pharmacy Claims Analysis Formularies Formulary management Medicare part d Operations support Pharmacy operations WebEx Clinical pharmacy Performance Evaluation +27

USD 105K+

Pharmacy Coordinator II
Remote-NV, United States

Centene Corporation

Formulary process Prior authorizations Grievances Managed care experience Health Plan Provider Relations Utilization Review Prior authorization Medical management +18

USD 77K+

Remote Medical Director (PRN) - California
Remote-CA, United States

Centene Corporation

Clinical quality improvement Clinical programs Health financing Medical Review Clinical Quality Personnel management Health Plan Health administration Medical Services +24

Exec Mid Part Time

USD 222K+

Pharmacy FWA Investigator I
Remote-FL, United States

Centene Corporation

Pharmacy fraud Waste and abuse Audit experience Retail Pharmacy Corrective action plans Government programs Claims analysis Pharmacy Technician Health Plan +31

Entry Mid Full Time

USD 44K+

Health Services Data Analyst – Sharp Community Medical Group – System Services Telecommuter – Day - FT
System Services-Telecommuter, United States

Sharp HealthCare

Monarch Managed care experience Database Development Microsoft Windows Data Reporting Spreadsheets Filing Medical management Utilization management +13

Entry Mid Full Time

USD 41K+

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

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management Prior authorization +19

USD 52K+

Appeals Specialist II
Remote-NY, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Full Time

USD 40K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

Autism spectrum disorder Healthcare Provider Interaction Medical appropriateness Clinical Standards Applied Behavior Analysis Treatment plans Behavioral Analysis ABA Clinical Review +25

USD 95K+

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