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Medical necessity Remote Jobs

21 fresh jobs found

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+

Clinical Reviewer - RN (Remote U.S.)
United States - Remote

URAC Strong organizational Urac standards Data Abstraction Medical record abstracting Web navigation Ncqa standards NCQA Medical Record Review +33

USD 44K+

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+

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+

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

Healthcare Auditing Audit Productivity Coding Principles Instructional Methods Concept Development Claims auditing Payment Decision Trees Clinical Guidelines +42

Senior Mid Full Time

USD 99K+

Utilization Clinical Reviewer (Remote within State of California)
Los Angeles, California, United States - Remote

Medicaid Knowledge Strong organizational Psychiatric care Data documentation Medical Record Review Mental health services Clinical Review Medical necessity Detail Orientation +35

USD 76K+

Behavioral Health Care Coordinator
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

PC experience Database experience Contract Interpretation Clinical Review Medical necessity PC Utilization Review Registered Nurse Database +9

USD 58K+

Behavior Health Utilization Management Care Coordinator (Remote)
Virginia Premier Health Plan Richmond

Transitions of care Cmhrs services Behavioral health care coordination Dmas protocols Arts services Bh services Managed care contracting Continuity of care Health Plan +16

USD 62K+

Medical Director - Pharmacy Appeals
Remote US

Medicare rules Commercial health insurance Clinical group practice management CMS policies Humana policies National Guidelines Rules Business Metrics Practice Management +55

Exec Senior Full Time

USD 199K+

Medical Director - Orthopedic Spine Surgeon - Remote - eviCore
Florida Work at Home

The Cigna Group

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

Exec Senior Full Time

USD 196K+

Utilization Management Manager - Denial Appeals and Audit
Working Virtually

MultiCare Health System

Medical necessity Discharge planning Cost Management Quality Standards Utilization management Supervisory Nursing Health care Audit +10

Senior Mid Full Time

USD 168K+

Assistant Medical Director
WA Western Telecommuter

Premera Blue Cross

Medical policy criteria Care transition management Claims review RBRVS InterQual MCG Clinical Review Medical necessity ICD +8

Exec Senior Full Time

USD 203K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania

Benefit utilization Coverage determination Benefit management Telephonic Communication Medical necessity Clinical Criteria Acute care Discharge planning Utilization Review +20

USD 58K+

Virtual Utilization Review Specialist - WEEKENDS
Work at Home - Akron - OH

Ensemble Health Partners

Healthcare resources Clinical review criteria Medical necessity determination Denial Management Medical necessity Clinical Review Utilization Review Revenue Cycle Management Patient Access +9

USD 57K+

Utilization Management Nurse Consultant
Work At Home-Ohio

Benefit utilization Coverage determination Benefit management Long Term Care Telephonic Communication Clinical Criteria Medical necessity Home Health Discharge planning +30

USD 52K+

Utilization Manager Nurse Consultant
Work At Home-Texas

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

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Texas

Benefit utilization Coverage determination Benefit management Long Term Care Telephonic Communication Medical necessity Clinical Criteria RN licensure Home Health +32

USD 58K+

UM Nurse Consultant - Prior Authorization
Work At Home-Ohio

Benefit utilization Coverage determination Benefit management Navigating multiple systems Medical necessity Clinical Criteria Keyboarding RN licensure Discharge planning +27

USD 52K+

Associate Medical Director, Cardiology
United States

Cohere Health Remote-first

Vascular medicine Clinical Decision Making Peer-to-peer discussions Evidence-Based Guidelines Software tools Clinical Intelligence Medical necessity Clinical Acumen Clinical Review +10

Senior Mid Full Time

USD 240K+

Utilization Managment Nurse Consultant
Work At Home-California

Benefit management Benefit utilization Coverage determination Long Term Care Clinical Criteria Medical necessity Telephonic Communication RN licensure Utilization Review +29

Entry Mid Full Time

USD 64K+

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