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Medical necessity Remote Jobs

16 fresh jobs found

Nurse Clinical Reviewer (RN)
North Dakota, United States - Remote

Asam guidelines Urac standards Interqual guidelines Ncqa standards Telephone etiquette Policy interpretation Medical Record Review InterQual Clinical assessment +24

USD 45K+

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Utilization Management Nurse Consultant
Work At Home-Ohio

Benefit utilization Benefit management Coverage determination Clinical Criteria RN licensure Medical necessity Utilization Review Healthcare services Clinical Judgment +21

USD 52K+

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Utilization Management Clinical Processor
Work From Home - AZ

X-ray review X-ray certification Dental benefit administration Windows-based programs Medical Necessity Review Clinical Review Medical necessity Clinical Judgment Utilization management +11

USD 57K+

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Utilization Clinical Reviewer (LCSW, LMFT, LPCC or LCPC) - Remote within CA
California, United States - Remote

HIPAA policies Public Sector Services Mental Health Assessments Psychiatric care Psychiatric Disorders Medicaid programs Clinical Review Medical necessity Public Sector +26

USD 58K+

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Auditor Clinical Validation DRG
Remote, United States

Audit tools Coding principles Coding terminology Medical claims billing Medical audit Chart validation Payer reimbursement policies Clinical coding Clinical Validation +35

USD 44K+

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UM Nurse Consultant - Prior Authorization
Work At Home-Ohio

Benefit utilization Benefit management Navigating multiple systems Coverage determination Clinical Criteria Keyboarding RN licensure Medical necessity Prior authorization +20

USD 52K+

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Behavioral Health Medical Director
Indianapolis, Indiana, United States - Remote

Healthcare Business Peer-to-Peer Consultations Medical Necessity Review Managed Care Strategies Medical management Medical expertise Strong organizational Clinical Oversight Psychiatry +22

Senior Full Time

USD 186K+

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

The Cigna Group

Peer-to-peer discussions Durable medical equipment Medical Review Internet Connectivity Medical necessity Clinical Guidelines Utilization Review Clinical services Utilization management +11

Exec Senior Full Time

USD 196K+

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

Instructional Methods Workflow Validation Healthcare Auditing Evaluation Procedures Audit Productivity Payer reimbursement policies Coding terminology Concept Development Chart validation +48

Senior Mid Full Time

USD 99K+

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Physician Medical Reviewer
Nashville, Tennessee, United States - Remote

Peer-reviewed research Expert testimony Medical Review Evidence-Based Medicine Medical necessity Utilization Review Clinical Practice Public Sector Administrative +13

Senior Mid Full Time

USD 184K+

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Dental Reviewers
Arkansas, United States - Remote

Managed Care Strategies Healthcare Trends Clinical consultations Clinical Oversight Disease Management Strong organizational Peer review Medical necessity Utilization Review +17

Senior Full Time

USD 226K+

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Auditor Clinical Validation OPSP Clinical
Remote, United States

Coding terminology Payer reimbursement policies Medical claims billing Chart validation Audit tools Medical audit Clinical Validation Medical necessity Coding accuracy +21

Senior Full Time

USD 44K+

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Clinical Reviewer - (LCSW, LMFT, LPCC or LCPC) Remote within California
California, United States - Remote

Mental Health Assessments Psychiatric care Psychiatric Disorders Public Sector Services HIPAA policies Medicaid programs Clinical Review Medical necessity Referrals +25

USD 82K+

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Dental Hygienist Clinical Utilization Reviewer - Remote
Arkansas, United States - Remote

Clinical dentistry Adjudication Guidelines Radiographs Dental terminology Dental Hygiene Medicaid programs Clinical Review Medical necessity Interdisciplinary Collaboration +16

USD 68K+

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Clinical Reviewer - Remote within State of Maine (LCSW or LCPC)
Portland, Maine, United States - Remote

Psychiatric care Mental Health Assessments Public Sector Services Psychiatric Disorders HIPAA policies Clinical Review Medicaid programs Medical necessity Referrals +23

USD 82K+

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Clinical Reviewer - Remote in California Phone Based (LCSW/LMFT/LPCC/LCPC)
Los Angeles, California, United States - Remote

Mental Health Assessments Psychiatric care Public Sector Services Psychiatric Disorders HIPAA policies Medicaid programs Clinical Review Medical necessity Referrals +23

USD 82K+

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