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Medical necessity Remote Jobs

49 fresh jobs found

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+

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+

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+

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+

Clinical Review Nurse - Prior Authorization
Getzville-105 Crosspoint Pkwy (11106), United States

Centene Corporation

Clinical reviews Authorization requests Health management Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Acute care +18

USD 95K+

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+

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+

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

Centene Corporation

Health management Health management systems Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical Records +15

USD 52K+

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+

RN Clinical Review Nurse - Concurrent Review
Remote-CA, United States

Centene Corporation

Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical management Clinical knowledge Utilization management +9

USD 93K+

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+

Clinical Review Clinician - Appeals
Remote-NY, United States

Centene Corporation

Clinical reviews Appeals processing Clinical data analysis Interdepartmental Collaboration Ncqa standards Medicaid regulations Appeals Clinical Review Medical necessity +19

USD 52K+

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+

Utilization Management Nurse Consultant
Work At Home-New York, United States

Healthcare services coordination Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication +25

USD 64K+

Coding Specialist
Work at Home - Ohio - Other, United States

Ensemble Health Partners

Lynx Coding applications Abstracting data Medical necessity checks Computerized assisted coding CPT IV Coding ethics 3M software Coding software +21

Entry Mid Full Time

USD 35K+

Remote Medical Director - Michigan
Remote-MI, 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 221K+

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

Centene Corporation

Clinical reviews Authorization requests Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Prior authorization Health Services +15

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Florida, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +21

USD 52K+

Appeals Nurse Consultant (Remote)
Work At Home-Connecticut, United States

Medicare guidelines Computer Systems RN licensure Appeals Medical necessity Typing Utilization management Clinical Experience RN +12

USD 66K+

Utilization Review Nurse Consultant - Oncology and Transplant
Work At Home-Arizona, United States

Evidence-based criteria Transplant Clinical call center Concurrent review Clinical Practice Guidelines Telephone Communication Navigating multiple systems Clinical Criteria Disease Management +21

Entry Mid Full Time

USD 52K+

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

Ensemble Health Partners

Healthcare Resource Management Clinical review criteria Medical necessity determination Medical Necessity Review Denial Management Clinical Review Medical necessity Color Utilization Review +15

USD 70K+

RN Nurse Case Management Lead Analyst - Work from Home, Anywhere, USA
Pennsylvania Work at Home, United States

The Cigna Group

Myndshft Nimble learning Clinical criteria review Cover My Meds Nurse Case Management Analytics Reporting Database navigation Decision quality Medical necessity +26

Senior Full Time

USD 76K+

Medical Director - Pediatric Infectious Disease - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Evidence-Based Decision Making Evidence-based medical reviews Case Management Software Automated processes Computer Applications Federal Laws Healthcare Regulations Medical necessity +22

Exec Senior Full Time

USD 203K+

Medical Director- Radiation Oncology - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Medical Case Management Evidence-based reviews Case Management Software Evidence-Based Decision Making Evidence-based medical reviews Automated processes Computer Applications Federal Laws +30

Exec Senior Full Time

USD 203K+

Clinical Evalution Manager, RN- mostly remote
220 East 42nd Street, United States

Health Care Policies Clinical evaluation Interdisciplinary Team Collaboration Telephonic case management Medical necessity Patient advocacy Care Coordination Utilization management Case Management +1

USD 85K+

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

The Cigna Group

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

Exec Senior Full Time

USD 203K+

Medical Director - Clinical Biochemical Genetics or Clinical Genetics - EviCore
Florida Work at Home, United States

The Cigna Group

Clinical genetics Clinical biochemical genetics Medical case reviews Evidence-Based Decision Making Case Management Software Evidence-based medical reviews Automated processes Evidence-based medicine Computer Applications +25

Exec Senior Full Time

USD 203K+

Medical Director - New Hampshire
Remote-NH, United States

Centene Corporation

Health financing Provider network development Medical management programs Health administration Health care quality Personnel management Medical Review Medical Services Accreditation Standards +27

Exec Senior Full Time

USD 206K+

Transition of Care Registered Nurse, Utilization Management (mostly remote)
220 East 42nd Street, United States

Evidenced Based Criteria Clinical Determination Healthcare Policies Medical necessity Prior authorization Care Coordination Registered Nurse Utilization management Case Management +3

USD 106K+

Auditor Clinical Validation DRG
Remote, United States

Chart validation Medical claims billing Coding Principles Audit tools Clinical coding Payment Coding accuracy DRG ICD-9 +34

USD 44K+

Utilization Management Nurse Consultant
Work At Home-Ohio, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +30

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania, United States

Keyboarding Coverage determination Healthcare Coordination Benefit utilization Benefit management Computer Systems Clinical Criteria Telephonic Communication RN licensure +25

USD 58K+

Utilization Manager Nurse Consultant
Work At Home-Texas, United States

Inpatient utilization Med/surg Coverage determination Benefit utilization Benefit management Clinical Criteria RN licensure Medical necessity Discharge planning +22

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Arizona, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Texas, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 58K+

Medical Director - Washington
Remote-WA, United States

Centene Corporation

Provider network development Medical management programs Health care quality Claims review Medical Review Cost Containment Medical necessity Medical management Utilization Review +8

Exec Mid Full Time

USD 206K+

Customer Service Representative
Work At Home-Texas, United States

Claims research Appeals Phone Medical necessity Healthcare Knowledge Referrals Call Center Health care Critical thinking +10

Entry Mid Full Time

USD 34K+

Medical Director - EviCore
Florida Work at Home, United States

The Cigna Group

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

Exec Senior Full Time

USD 196K+

Pre-Authorization Registered Nurse
Remote US, United States

MHK CGX Medical management systems MAccess Rehab Health Plan Experience MCG InterQual Medical necessity +49

USD 71K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Evidence-Based Guidelines Peer-to-peer discussions Software tools Clinical Review Medical necessity Clinical Intelligence Clinical Acumen Utilization Review +12

Senior Mid Full Time

USD 200K+

Senior Claims Benefit Specialist - Remote
Work At Home-Minnesota, United States

Medical claim processing Claim adjudication Claims Adjudication Cost Containment Outbound Calls Appeals Phone Medical necessity Eligibility verification +9

Senior Mid Full Time

USD 36K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Evidence-Based Guidelines Peer-to-peer discussions Clinical Decision Making Software tools Clinical Review Medical necessity Clinical Intelligence +12

Senior Mid Full Time

USD 200K+

Appeals Nurse
HGB SCA Remote KY

TRICARE policies Tricare DRG ICD-9 Medical Documentation Accreditation Peer review MCG ICD +44

USD 69K+

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

Centene Corporation

Accreditation Standards Clinical Supervision Medical necessity Medical management Utilization Review Utilization management RN Nursing Healthcare services +10

USD 72K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Health care quality Medical management programs Culturally diverse care Health financing Provider network development Health administration Accreditation Standards Medical Review Personnel management +17

Exec Senior Full Time

USD 227K+

Behavioral Health Care Planner
Work At Home - Utah

Medical necessity Administrative Support Health Insurance Health care Behavioral health Microsoft Office Suite Mental Health Clinical Outlook +10

USD 42K+

Utilization Management Nurse Consultant
Work At Home-Washington

Med/surg Coverage determination Long Term Care Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Telemetry +30

Senior Mid Full Time

USD 64K+

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