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Medical necessity Remote Jobs

52 fresh jobs found

DME Customer Order Specialist - PST Hours
United States - Remote

Kestra Medical Technologies, Inc

Pre-authorization Durable Medical Equipment Adobe Acrobat Pro Prior authorizations ICD-10 codes Insurance Verification Medical necessity Medical Billing Appeals +20

USD 60K+

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+

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+

Episodic Care Manager
Full Time Remote - North Carolina, United States

Medical necessity assessment Health care coordination Case review Clinical reviews Clinical evaluation Medical policy Medical necessity Clinical Documentation Clinical knowledge +7

USD 68K+

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+

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+

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 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+

Payer Solutions Inpatient UM Case Management Lead Analyst - Evernorth Health Services - Remote
Minnesota Work at Home, United States

The Cigna Group

Chemical dependency Health care services Technology systems Treatment plans Medical necessity Discharge planning Behavioral healthcare Utilization Review Conflict Management +25

Senior Mid Full Time

USD 65K+

Medical Director - Pediatric Pulmonology - EviCore - Remote
Florida Work at Home, United States

The Cigna Group

Evidence-based medical reviews Evidence-Based Decision Making Medical case reviews Automated processes Case Management Software Federal Laws Computer Applications Healthcare Regulations Medical necessity +23

Exec Senior Full Time

USD 203K+

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+

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+

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+

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+

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+

Auth Insurance Verification Specialist
Working Virtually, United States

MultiCare Health System

Admitting Pre-authorization Authorization Management Authorizations Referral management Medical Assistant Registration Insurance Billing Insurance Verification +20

USD 40K+

Behavioral Health Care Coordinator (Outpatient Services)
Downers Grove (3500 Lacey Road), United States

Health Care Service Corporation

PC experience Database experience Contract Interpretation Clinical Review Medical necessity PC Utilization Review Registered Nurse Database +13

USD 60K+

Clinical Review Clinician - Appeals (RN)
Remote-TX, United States

Centene Corporation

Appeals process Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity Medical Records +23

USD 95K+

Medical Director - Kansas
Remote-KS, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Medical Review Accreditation Standards +38

Exec Senior Full Time

USD 221K+

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

Centene Corporation

Grievance Ncqa standards Grievances NCQA Quality Metrics Medical necessity Clinical operations Appeals Medical management +28

USD 68K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

Nurse Auditor
Remote US, United States

Medical necessity auditing Clinical audit Tricare Diagnosis coding Coding certification Medical record documentation Medical claims Medical Record Review CPT codes +49

USD 78K+

Remote Behavioral Medical Director - western region
Remote-CA, United States

Centene Corporation

Clinical practice improvement Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Accreditation Standards +36

Exec Senior Full Time

USD 231K+

Remote Behavioral Medical Director – West Region
Remote-CA, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Medical Review +36

Exec Senior Full Time

USD 231K+

Virtual Utilization Review Specialist - PART TIME WEEKENDS
Work at Home - Akron - OH, United States

Ensemble Health Partners

Healthcare Resource Utilization Clinical review criteria Medical necessity determination Medical Necessity Review Medical Record Review Denial Management Clinical Review Medical necessity Utilization Review +18

USD 57K+

Medical Director -Pediatric Cardiology
Florida Work at Home, United States

The Cigna Group

Medical case reviews Evidence-based medical reviews Evidence-Based Decision Making Case Management Software Automated processes Federal Laws Healthcare Regulations Computer Applications Utilization Review +23

Exec Senior Full Time

USD 203K+

Remote Child & Adolescent Behavioral Medical Director - Washington
Remote-WA, United States

Centene Corporation

Adverse trend evaluation Clinical quality improvement Medical Necessity Review Provider network development Medical management programs Health care quality Health financing Clinical collaboration Personnel management +36

Exec Mid Full Time

USD 231K+

Clinical Review Clinician - Appeals
Remote-MO, United States

Centene Corporation

Appeals processing Interdepartmental Collaboration Clinical data analysis Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity +25

USD 52K+

Remote Medical Director - Arizona
Remote-AZ, United States

Centene Corporation

Health financing Medical management programs Provider network development Health care quality Personnel management Government programs Medical Review Accreditation Standards Health administration +34

Exec Senior Full Time

USD 221K+

National Medicaid Medial Director - Long Term Services & Supports (LTSS)
Remote US, United States

Medical Authorization Community Groups Health Care Facilities Long Term Services & Supports Therapy Services Social determinants Post-acute care Clinical reference materials Medical background +73

Exec Senior Full Time

USD 223K+

Case Manager - NICU/Pediatrics
Full Time Remote - North Carolina, United States

Healthcare resources Multidisciplinary collaboration Comprehensive assessments Member education Monitoring and Evaluation Clinical assessment Discharge planning Medical necessity Treatment Planning +11

USD 68K+

Auditor Technical Trainer (Outpatient/Specialty Audits)
Remote, United States

Audit Productivity Healthcare Auditing Chart validation Coding Principles Provider Billing Claims auditing Decision Trees Payment Concept Development +45

Senior Mid Full Time

USD 99K+

RN Clinical Auditor
Work at Home - Ohio - Other, United States

Ensemble Health Partners

Clinical auditing CMS rules Nursing practices Healthcare Standards DRG EMR systems Healthcare Regulations Electronic Medical Records Medical necessity +23

USD 56K+

Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
Tennessee Work at Home, United States

The Cigna Group

Case conferences Medical care management Board certification Educational training Ncqa standards Peer-to-peer discussions Medical Review Quality of care Federal Laws +21

Exec Senior Full Time

USD 203K+

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+

Episodic Care Manager (Multiple Positions)
Full Time Remote - North Carolina, United States

Clinical analysis Health care coordination Clinical evaluation Case review Medical necessity Clinical Documentation Collaboration Communication

USD 61K+

Behavioral Health Inpatient Care Manager - Initial Clinical Examiner Team- Evernorth Health Services- Remote
California Work at Home, United States

The Cigna Group

Technology navigation Technology systems Treatment plans Mental Health Counseling Medical necessity Behavioral healthcare Utilization Review Discharge planning Health Services +25

USD 65K+

Quality Improvement Coordinator - Behavioral Health
Remote-WA, United States

Centene Corporation

Clinical Nursing Grievances Quality of care Clinical Quality Program Evaluation Healthcare administration Appeals HEDIS Medical necessity +19

USD 66K+

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+

Clinical Investigator Behavioral Health
Remote-MO, United States

Centene Corporation

Investigative support Provider education Medical necessity Fraud detection Procedures Medical Records Report Writing CMS Claims +14

USD 55K+

Case Manager
Full Time Remote - North Carolina, United States

Comprehensive assessments Health coaching Discharge planning Medical necessity Referrals Care Coordination Community Resources Policy Development Case Management +7

USD 68K+

Medical Review Analyst
Full Time Remote - North Carolina, United States

Computer application software Clinical analysis Medical policy Claims analysis Billing and Coding Medical necessity Medical Records Clinical expertise Root Cause Analysis +9

USD 61K+

Behavioral Health Case Manager - Medicare Advantage
Full Time Remote - North Carolina, United States

Comprehensive assessments Clinical assessment Discharge planning Medical necessity Referrals Community Resources Utilization management Behavioral health Case Management +10

USD 61K+

Case Manager - D-SNP
Full Time Remote - North Carolina, United States

Health coaching Clinical assessments Medical necessity Referrals Discharge planning Treatment Planning Community Resources Care Coordination Resource Management +6

USD 68K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Retrospective review Concurrent review Accreditation Compliance Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes +20

USD 70K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Concurrent review Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes Clinical Review Medical necessity Utilization Review +18

USD 66K+

Case Manager - Commercial
Full Time Remote - North Carolina, United States

Comprehensive assessments Health coaching Education and Training Medical necessity Referrals Discharge planning Community Resources Care Coordination Policy Development +6

USD 68K+

Clinical Evaluation Manager, Utilization Management (mostly remote)
220 East 42nd Street, United States

Patient care planning Clinical determinations Clinical evaluation Healthcare Policies Medical Services Medical necessity Prior authorization Care Coordination Utilization management +9

USD 106K+

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