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Medical necessity Remote Jobs

38 fresh jobs found

Medical Director - Medicare Grievances and Appeals - Weekend
Remote US, United States

Health claims analysis Preservice appeals Healthcare Provider Collaboration Rehab Remote work setup Appeals processing Health claims Hospitalist Medical background +52

Exec Mid Full Time

USD 246K+

PAC Nurse
Remote

Project participation Patient status monitoring Inter-rater reliability Milliman Managed care regulations Evidence-based care guidelines URAC Ncqa standards Home health care +30

USD 72K+

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

Computer application software Medical literature Claims analysis Medical policy Medical necessity Medical Records Clinical expertise Healthcare services Claims +12

USD 68K+

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

Centene Corporation

Inpatient Services Education to Providers Provider collaboration Medical necessity evaluation Health management systems Concurrent review Health management Medicaid regulations Resource Utilization +33

USD 52K+

Trauma Surgery Coding Associate III
Remote, ID, United States

Coding for Diagnoses and Procedures Coding Productivity Standards Coding Querying Charge Corrections CCI Edit Software Medical Record Abstraction Medical Documentation Review Coding Quality Standards Coding for Treatments and Procedures +52

USD 62K+

Clinical Care Reviewer - Board Certified Behavioral Analyst
Dayton WFH, United States

ASAM Change resiliency Evidence-based care systems Medical advisement Durable Medical Equipment LSW Medical Necessity Review Proper grammar usage Phone Etiquette +44

USD 61K+

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

Centene Corporation

Health management systems Concurrent review Health management Medicaid regulations Clinical Review Utilization Medical necessity Medical management Health Services +21

USD 95K+

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

Centene Corporation

Education provision Healthcare provider coordination Clinical information documentation Authorization requests Health management systems Service authorization Medical appropriateness Health management Medicaid regulations +29

USD 52K+

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

Centene Corporation

Healthcare provider coordination Clinical information documentation Health management systems Authorization requests Service authorization Medical appropriateness Health management Medicaid regulations Clinical reviews +27

USD 95K+

Clinical Review Clinician - Appeals
Remote-CA, United States

Centene Corporation

Case reviews Interdepartmental Collaboration Ncqa standards Medicaid regulations Clinical reviews Researching Clinical Review NCQA Medical necessity +27

USD 95K+

Inpatient Coder/Abstractor Remote
Sentara Martha Jefferson Health Information Management, United States

Encoder software ICD-10-PCS Coding compliance Documentation Improvement CPT-4 Medical necessity ICD-10-CM Physiology Acute care +20

USD 48K+

Clinical Care Analyst
United States

Healthmap Solutions

Chart auditing Social Determinants of Health Medical necessity Clinical assessment Utilization Review Healthcare services Care management Multitasking Critical thinking +5

USD 70K+

Clinical Program Director
United States

Cohere Health Remote-first

Measurable outcomes Clinical program development Inpatient care Evidence-Based Guidelines Clinical Strategy Clinical Guidelines Clinical Review Clinical programs Medical necessity +16

Exec Senior Full Time

USD 160K+

Corporate Medical Director - Medicare Grievances and Appeals (32-Hours)
Remote US, United States

Preservice appeals Rehab Health claims Grievances Hospitalist Family practice Medical interpretation Medical background Geriatrics +43

Exec Senior Full Time

USD 246K+

Psychologist Reviewer
Remote-AZ, United States

Centene Corporation

Diagnostic evaluations Psychological testing Clinical Information Behavior Analysis Utilization Psychology Medical necessity Health Services Substance abuse +17

USD 86K+

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

Centene Corporation

UM Accreditation Standards Compliance monitoring Utilization Guidelines Medical necessity Clinical Supervision Performance Evaluation Medical management +31

USD 73K+

Remote Medical Director - California
Remote-CA, United States

Centene Corporation

Adverse trend evaluation Medical Necessity Review Health financing Medical management programs Provider network development Health care quality Clinical quality improvement Health administration Government programs +44

Exec Senior Full Time

USD 231K+

Medical Director - EviCore - Remote (Family Medicine, Internal Medicine or Emergency Medicine)
Florida Work at Home, United States

The Cigna Group

Evidence-based medical reviews Medical case reviews Evidence-Based Decision Making Cigna Automated processes Federal Laws Clinical Judgment Computer Applications Case Management Software +24

Entry Mid Full Time

USD 203K+

RN Clinical Review Clinician - Appeals
Remote-CA, United States

Centene Corporation

Medical Records Review Interdepartmental Collaboration Case reviews UM Ncqa standards Medicaid regulations Clinical reviews Researching Clinical Review +30

USD 52K+

Clinical Appeal Nurse - Remote $10K Sign on Bonus
United States

Tenet Healthcare

Patient accounting knowledge Electronic tools Medical necessity criteria Denials management ACE InterQual UB04 Patient Accounting Managed Care Contracts +32

USD 92K+

Senior Inpatient Clinical Research Specialist
United States

Cohere Health Remote-first

Payer um reviews Inpatient admission Ai optimization Clinical Review Clinical Intelligence Technology applications Medical necessity Acute care Agility +21

Senior Full Time

USD 75K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Healthcare Programs Retrospective review Concurrent review Accreditation Compliance Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity +24

USD 66K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Review Clinical Intelligence Medical necessity Clinical Acumen Operational Improvements +11

Senior Mid Full Time

USD 200K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Healthcare Programs Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity Acute care Prior authorization +23

USD 70K+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Orthopedic spine surgery Spine surgery Neurosurgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Review Clinical Intelligence Medical necessity +13

Senior Mid Full Time

USD 250K+

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

The Cigna Group

Case conferences Medical licenses Board certifications Peer-to-peer discussions Cigna Ncqa standards Federal Laws Medical Review Clinical Review +21

Exec Senior Full Time

USD 203K+

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

Centene Corporation

Complaints resolution Appeals management Quality Initiatives CDP Grievances Clinical quality improvement Clinical Nursing Clinical Quality Program Evaluation +28

USD 66K+

Medical Director
Remote-IL, United States

Centene Corporation

Health financing Health care quality Medical management programs Substance Use Disorders Provider network development Clinical quality improvement Government programs Clinical Quality Substance use +45

Exec Senior Full Time

USD 221K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity Clinical Acumen Utilization Review +11

Senior Mid Full Time

USD 200K+

Hospital Surgery/Observation Coder
Centennial, CO, United States

CommonSpirit Health Mountain Region

Coding queries 3m encoder NCCI edits NCCI Data Retrieval Abstracting Medical necessity CPT coding CPT +5

USD 50K+

RC Appellate Clinician - Remote
United States

Tenet Healthcare

Electronic tools Medical necessity criteria ACE Denials management UB04 Patient Accounting InterQual Managed Care Contracts EOB +29

USD 92K+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Neurosurgery Orthopedic surgery Spine surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity +14

Senior Mid Full Time

USD 250K+

Auditor Clinical Validation DRG
Remote, United States

Medical claims billing Payer reimbursement policies Coding terminology Medical audit Clinical chart validation Chart validation Payer reimbursement Coding Principles Billing guidelines +45

USD 45K+

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

Ensemble Health Partners

3M Software Lynx CPT IV Coding ethics Coding software ICD-10-PCS Abstracting ICD-10-CM Health Information Management +25

USD 35K+

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

The Cigna Group

Evidence-based reviews Evidence-Based Decision Making Evidence-based medical reviews Medical case reviews Case Management Software Federal Laws Automated processes Computer Applications Cigna +25

Exec Senior Full Time

USD 203K+

Utilization Review Nurse
Remote

Clinical auditing Clinical Guidelines Medical necessity Utilization Review Medical Billing Prior authorization Microsoft Suite Quality improvement Healthcare services +12

USD 80K+

RC Appellate Clinician - Remote
United States

Tenet Healthcare

Medical necessity criteria UB04 Denials management Patient Accounting Managed Care Contracts InterQual EOB Healthcare industry expertise Healthcare Management +27

USD 92K+

Remote Marketplace Medical Director
Remote-MO, United States

Centene Corporation

Claims review Medical management programs Provider network development Government programs Health care quality Health financing Clinical quality improvement Personnel management Health administration +39

Exec Mid Full Time

USD 231K+

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