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Medical necessity Remote Jobs

13 fresh jobs found

Physical Therapist Reviewer PRN (Remote - Within Alabama)
Alabama, United States - Remote

Medicare Policies Medicaid Policies Strong organizational Disease Processes Medical record abstracting Medical Record Review Medical necessity Rehabilitation Prior authorization +24

USD 84K+

Associate Medical Director, Cardiology
United States

Cohere Health Remote-first

Vascular medicine Clinical Decision Making Peer-to-peer discussions Evidence-Based Guidelines Software tools Clinical Intelligence Medical necessity Clinical Acumen Clinical Review +10

Senior Mid Full Time

USD 240K+

Utilization Managment Nurse Consultant
Work At Home-California

Benefit management Benefit utilization Coverage determination Long Term Care Clinical Criteria Medical necessity Telephonic Communication RN licensure Utilization Review +29

Entry Mid Full Time

USD 64K+

Medical Director - Pharmacy Appeals
Remote US

Medicare rules Clinical group practice management Humana policies National Guidelines CMS policies Rules InterQual MCG Medical Director +51

Exec Senior Full Time

USD 199K+

Medical Claims Adjustor (Fully Remote)
Work At Home-Minnesota

Dg system claims processing Claim adjudication Medical claims processing Eligibility verification Appeals Claims Adjudication Cost Containment Medical necessity Claims processing +8

USD 36K+

Medical Director -Pediatric Surgery
Florida Work at Home

The Cigna Group

Evidence-based reviews Evidence-Based Decision Making Automated processes Case Management Software Computer Applications Federal Laws Medical necessity Healthcare Regulations Utilization Review +21

Exec Senior Full Time

USD 196K+

Utilization Management Clinical Processor - Dental
Work From Home - AZ

Dental benefit administration X-ray review Windows-based programs Medical Necessity Review Confidential information handling Medical necessity Clinical Judgment Utilization management Leadership Development +16

USD 36K+

Medical Director, Durable Medical Equipment - Work from home - Evernorth
Tennessee Work at Home

The Cigna Group

Guideline review State and federal laws Case processing Educational training Clinical resource Ncqa standards Board certification Urac standards Medical Review +15

Exec Senior Full Time

USD 196K+

Clinical Peer Reviewer (Psychologist-Behavior Analyst) – Evernorth Health Services - Remote
Minnesota Work at Home

The Cigna Group

Behavioral health consulting Managed care experience Psychiatric diagnosis Clinical policy development Clinical Guidelines Provider Relations Health Services Clinical Training Medical necessity +23

Senior Mid Full Time

USD 103K+

Behavioral Health Inpatient UM Care Manager - Evernorth Health Services - Remote
Minnesota Work at Home

The Cigna Group

Chemical dependency Technology systems Health Services Medical necessity Utilization Review Conflict Management Community Resources Insurance Industry Clinical knowledge +22

USD 65K+

Associate Medical Director, Orthopedic Spine Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Software tools Evidence-Based Guidelines Operational Improvements Clinical Intelligence Clinical Acumen Clinical Review Medical necessity +8

Senior Mid Full Time

USD 240K+

Associate Medical Director, Pain Management
United States

Cohere Health Remote-first

Pain management Peer-to-peer discussions Evidence-Based Guidelines Software tools Operational Improvements Clinical Intelligence Clinical Acumen Technology Proficiency Clinical Review +10

Senior Mid Full Time

USD 240K+

Clinical Reviewer - 10-hour shift starting at 10am
Harrisburg, Pennsylvania, United States - Remote

Disease process Ncqa standards Medical record abstracting Cms standards Urac standards Telephone etiquette Medical Record Review Prior authorization Rehabilitation +24

USD 44K+

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