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Medical necessity Remote Jobs

44 fresh jobs found

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+

Case Manager
Full Time Remote - North Carolina, United States

Health coaching Comprehensive assessments Medical necessity Discharge planning Treatment Planning Community Resources Care Coordination Referrals Policy Development +9

USD 68K+

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+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Clinical Information Clinical Review +25

Senior Mid Full Time

USD 60K+

Sr Onsite Clinical Care Navigator--Mission Hospital Asheville
Full Time Remote - North Carolina, United States

Clinical reviews Comprehensive assessments Healthcare Coordination Medical necessity Discharge planning Clinical Care Community Resources Referrals Utilization management +7

Senior Mid Full Time

USD 75K+

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+

RN Clinical Review Clinician_Appeals
Remote-CA, United States

Centene Corporation

Appeals processes Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations Researching NCQA Clinical Review Guidelines +27

USD 95K+

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+

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

Centene Corporation

Appeals management Grievance Grievances Ncqa standards Quality Metrics NCQA Regulatory reporting Medical necessity Appeals +31

USD 68K+

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+

UM Coordinator
Work From Home (HB), United States

Health Care Service Corporation

Medical claims review Ancillary services UM Medical Necessity Review Medical claims Healthcare Management Report Preparation Medical necessity Registered Nurse +20

USD 56K+

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+

Pre-Authorization Registered Nurse
Remote US, United States

Medical management systems Rehab Medicaid Experience Health Plan Experience Microsoft Office Word Clinical Nursing InterQual MCG Rehabilitation +53

USD 71K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Medical necessity Clinical Review Discharge planning Utilization Acute care +20

USD 95K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Culturally diverse care Medical management programs Health care quality Health financing Provider network development Government programs Clinical quality improvement Health administration Accreditation Standards +41

Exec Senior Full Time

USD 231K+

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

Centene Corporation

Service authorization Medical appropriateness Authorization requests Health management systems Clinical reviews Health management Medicaid regulations Guidelines Clinical Information +23

USD 95K+

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

Centene Corporation

Health management systems Health management Medicaid regulations Guidelines Clinical Review Medical necessity Discharge planning Utilization Acute care +20

USD 95K+

Medical Director - Plastic Surgery
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+

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

Centene Corporation

Regulations Compliance UM Guidelines Accreditation Standards Clinical Supervision Medical necessity Utilization Accreditation Utilization Review +28

USD 73K+

Senior Healthcare Analyst, Actuarial
United States

Cohere Health Remote-first

Claims Data Actuarial modeling Clinical Intelligence Cost Containment Client-facing Healthcare Analytics Financial Forecasting Medical necessity Prior authorization +36

Senior Mid Full Time

USD 100K+

Clinical Review Nurse - Prior Authorization (RN)
Remote-CA, United States

Centene Corporation

RN licensure Service authorization Medical appropriateness Authorization requests Guidelines Clinical reviews Health management systems Medicaid regulations Health management +24

USD 95K+

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

Centene Corporation

TruCare Health management systems InterQual Guidelines Health management Medicaid regulations Clinical Review Medical necessity Discharge planning +22

USD 52K+

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+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Claims review Health financing Medical management programs Provider network development Health care quality Government programs Clinical quality improvement Health administration Personnel management +40

Exec Mid Full Time

USD 231K+

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+

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

Centene Corporation

Health management systems Health management Medicaid regulations Utilization Medical necessity Clinical Review Discharge planning Acute care Medical Records +20

USD 52K+

Remote Medical Director (PRN) - Missouri
Remote-MO, United States

Centene Corporation

Education Development Claims review Medical management programs Provider network development Government programs Health care quality Clinical quality improvement Health financing Personnel management +41

Exec Mid Part Time

USD 212K+

Outpatient Coder/Abstractor
Sentara HIM Landstown, United States

Encoder software Outpatient coding CPT-4 Physiology ICD-10-CM Anatomy CPT coding Medical necessity Acute care +15

Entry Mid Full Time

USD 59K+

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

Patient care planning Healthcare Policies Clinical evaluation Medical Services Medical necessity Prior authorization Care Coordination Utilization management Care management +12

USD 106K+

UM Coordinator 2 (Bilingual)
Remote US, United States

Process Navigation Computations ICD-10 codes Process Flows ICD Microsoft Office Applications Medical necessity Utilization Review Prior authorization +51

Entry Full Time

USD 40K+

UM Coordinator 2
Remote US, United States

Clinical information review Computations ICD-10 codes Process Flows ICD Microsoft Office Applications Medical necessity Utilization Review Prior authorization +52

Entry Mid Full Time

USD 40K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Peer-to-peer discussions Clinical Decision Making Evidence-Based Guidelines Software tools Gastroenterology Clinical Intelligence Patient outcomes +18

Senior Mid Full Time

USD 200K+

Auditor Clinical Validation OPSP Clinical
Remote, United States

CMS security Clinical chart validation Medical record coding Cotiviti encoder Coding Principles Payer reimbursement Healthcare Auditing Billing guidelines Technological improvements +36

Senior Mid Full Time

USD 44K+

Medical Director
Remote-OH, United States

Centene Corporation

Substance Use Disorders Medical management programs Clinical quality improvement Health care quality Utilization Provider network development Government programs Health financing Accreditation Standards +45

Exec Senior Full Time

USD 221K+

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+

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+

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+

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+

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+

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+

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