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Prior authorization Remote Jobs

55 fresh jobs found

UM Administrative Coordinator
Remote US, United States

ICD-10 codes ICD Consumer Experiences Clinical Information Home Health Prior authorization Processes Utilization Review ICD-10 +44

Entry Mid Full Time

USD 40K+

Patient Experience Liaison - Michigan
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Treatment access Healthcare Landscape Pharmacy Claims Medical claims Strategic Mindset Patient experience Insurance coverage Healthcare Environment +31

USD 117K+

Case Manager, Patient Services (West Coast Based Candidates)
Remote (United States), United States

PTC Therapeutics, Inc.

Peer-to-peer review Pharmacy billing Appeals Patient Engagement Prior authorization Patient services Active Listening Case Management Quality +10

USD 81K+

Sr Field Reimbursement Manager – HIV Prevention Cincinnati, OH
US - OH - offsite, Estados Unidos

Gilead Sciences

Strategic Education Healthcare Policies Payer policies HIV Prevention Reimbursement processes Therapies Prior authorization Vision Patient Support +22

Senior Mid Full Time

USD 153K+

Patient Experience Liaison - Cleveland
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Treatment access Healthcare Landscape Pharmacy Claims Patient experience Insurance coverage Healthcare Environment Impactful Communication Health Science +29

USD 117K+

Patient Experience Liaison-Illinois-Michigan
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Medication Access Treatment access Healthcare Landscape Medical claims Strategic Mindset Patient experience Insurance coverage Healthcare Environment +32

USD 117K+

Claims Clinical Documentation Reviewer
REMOTE OPTIONS, PHOENIX

State of Arizona

Healthcare laws Prepayment claims review Medical necessity evaluation Audit reporting Service planning Claims review Medicaid programs Stakeholder Coordination Documentation Review +61

USD 68K+

I&I Field Reimbursement Manager, Wisconsin and Iowa
USA - WI - Remote, United States

Provider networks Co-pay assistance programs Specialty drug reimbursement Government payment systems Co-pay assistance Business Communication Outcomes Access and Reimbursement Compliance Guidelines +23

Senior Full Time

USD 135K+

Utilization Review Clinician - ABA
Remote-FL, United States

Centene Corporation

ABA services Autism spectrum disorder Medical appropriateness Applied Behavioral Analysis Behavioral Analysis Clinical Standards Healthcare Provider Interaction Applied Behavior Analysis ABA +28

USD 52K+

UM Pharmacy Technician (Work from Home)
California, United States

Health plan services Pharmacy utilization management Clinical pharmacy Electronic Health Records Prior authorization Medical management Microsoft Office Analytical Problem-solving +1

USD 81K+

Adherence Navigator LPN
Remote

Cognitive Behavioral Therapy LPN Prior authorization Motivational interviewing Patient Support Telehealth Time Management CRM Attention to detail +4

USD 48K+

Reimbursement Case Manager
Remote

Medical Benefits Reimbursement processes Benefit investigations Pharmacy benefits HIPAA regulations Patient advocacy Prior authorization HIPAA Compliance Patient Support +11

USD 38K+

Billing Strategy Lead, Prior Authorizations
US Remote

Prior authorization operations Prior authorizations PHI Privacy HIPAA/PHI Privacy PHI Business Intelligence Tools Women's Health Security Training Healthcare Billing +45

Senior Mid Full Time

USD 90K+

Billing Strategy Lead, Payment Posting
US Remote

Payment posting PHI Privacy HIPAA/PHI Privacy PHI Business Intelligence Tools Women's Health Security Training Healthcare Billing Cell-free DNA +60

Senior Mid Full Time

USD 90K+

Billing Strategy Lead, Patient Billing
US Remote

Patient billing operations PHI Privacy HIPAA/PHI Privacy PHI Business Intelligence Tools Women's Health Security Training Healthcare Billing Cell-free DNA +60

Senior Mid Full Time

USD 90K+

Customer Service Representative 3
REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX

State of Arizona

Computer Information Systems Medical eligibility Heaplus Billing procedures Statistical reporting Spreadsheet Applications Medicaid programs Policies and procedures Researching +40

Entry Mid Full Time

USD 36K+

Vice President, Children's Health-Care Management
Remote-FL, United States

Centene Corporation

Health outcomes initiatives Medicaid compliance Population health strategy Executive leadership Provider contracts UM Quality Initiatives Compliance requirements Clinical programs +57

Exec Senior Full Time

USD 182K+

Patient Access Specialist
USA - PA - Remote, United States

AmerisourceBergen

Benefits verification Patient assistance Billing and Coding Appeals Prior authorization Medical Billing Patient services Patient Access Healthcare industry +31

USD 42K+

Field Reimbursement Manager-Rheumatology
Remote, US, United States

Kevzara connect Access Issue Resolution Payer landscape Prior authorizations Reimbursement support Financial assistance Rheumatology Patient Support Programs Patient Support Services +31

USD 122K+

Prior Authorization Specialist
Remote

Appeals process Careviso Mac OS X Xifin HIPAA regulations Healthcare Billing Google Apps CRM applications CAP +18

USD 70K+

Field Reimbursement Specialist
USA - IL - Remote, United States

AmerisourceBergen

Coverage management Formulary Specialty distribution Buy and bill Benefit investigations Pharmacy benefits Educational presentations Patient assistance Reimbursement support +30

USD 86K+

Analyst, PA Accel
United States

Navitus Health Solutions, LLC

NCPDP PBM knowledge Benefit configuration Business Judgment System testing Pharmacy benefit management Prior authorization Health Root Cause Analysis +12

Entry Mid Full Time

USD 55K+

Manager, Clinical Pharmacy Operations (Medicare Part D)
Remote-TX, United States

Centene Corporation

Pharmacy Claims Operations support Formulary management Pharmacy operations Clinical pharmacy Medicare part d WebEx Utilization Performance Evaluation +31

USD 105K+

Utilization Review Nurse-Weekends-Remote
Sentara Park 1330, United States

Concurrent review Inpatient review RN license Retrospective review Milliman InterQual NCQA Discharge planning Health Plan +16

USD 60K+

Supervisor, Access Patient and Support
US-Nationwide-FIELD, United States

Cardinal Health Remote-first

Co-Pay Enrollment Program metrics Benefit investigations HR Management IT solutions Pay equity Prior authorization Enrollment Performance Improvement +28

USD 66K+

Senior Business Analyst
Lakewood, CO, US, 80227

Gainwell Technologies

Business Rules Modeling Requirements Traceability Management Visualization Modeling Medical claims processing Relational Database Software Test Case Development Design Specifications Re-engineering ALM +54

Senior Full Time

USD 69K+

Prior Authorization Specialist
United States

DrFirst Remote-first

Insurance Verification Healthcare IT Technology Proficiency Prior authorization Adaptability Security Research Problem-solving

USD 40K+

Clinical Account Manager
Remote-MO, United States

Centene Corporation

Managed care pharmacy Disease state management Drug Utilization Review Drug therapy Clinical interventions Managed healthcare Clinical data analysis Benefit design Formulary management +30

USD 105K+

Pharmacy Coordinator
Remote-IN, United States

Centene Corporation

Formulary process Prior authorizations Grievances Employee Training Pharmacy Technician Provider Relations Utilization Health Plan Utilization Review +21

USD 64K+

Clinical Systems Application Architect III
Dayton WFH, United States

Aerial 275 Jiva Zeomega Medecision Medhok Care management packages Healthedge Sdoh +75

Senior Full Time

USD 110K+

Manager, Prior Authorization Strategy & Policy Advocacy
US Remote

Payer interactions Business Objects Data-driven strategies Cell-free DNA Policy analysis Collection Genetic Testing Prior authorization Healthcare administration +23

USD 95K+

Field Reimbursement Specialist - Birmingham, AL
US - Alabama - Montgomery - Field/Remote, United States

Patient health information Benefits investigation Payer prior authorization Reimbursement Process Budgets Claims resolution Denials Payer Reimbursement Issues +48

USD 155K+

Clinical Account Executive (RPh)
United States

Navitus Health Solutions, LLC

Drug Literature Interpretation Clinical Trial Evaluation Pharmacy Claims Formulary management Clinical Strategy Clinical programs Prior authorization MS PowerPoint Client Services +15

Exec Mid Full Time

USD 112K+

Field Reimbursement Manager, Respiratory and Dermatology - Pensacola, FL/ Mobile, AL
Remote, US, United States

Access Issue Resolution Reimbursement support Respiratory Financial assistance Patient Support Services Patient Support Programs Dermatology Appeals Prior authorization +29

Senior Mid Full Time

USD 122K+

Field Reimbursement Specialist - Detroit, MI
US - Michigan - Detroit-Field/Remote, United States

Benefits investigation Payer prior authorization Patient health information Reimbursement Process Budgets Claims resolution Denials Payer Access and Reimbursement +48

USD 155K+

Senior Field Reimbursement Specialist
USA - DC - Remote, United States

AmerisourceBergen

Specialty distribution Formulary Coverage management Buy and bill Benefit investigations Educational presentations Patient assistance Pharmacy benefits Reimbursement support +58

Senior Full Time

USD 98K+

Supervisor, UM Reporting
United States

Navitus Health Solutions, LLC

Program audits PBM knowledge Data Quality Assurance Prior authorization Utilization management Health Pharmacy Creativity Medicaid +10

Senior Mid Full Time

USD 61K+

Pharmacy Care Navigator
IL - Remote, United States

Cityblock Health

Copay assistance Third party billing Medication Reconciliation Quality Initiatives Medication Adherence Pharmacy Technician CPT codes Prior authorization EHR +7

Senior Full Time

USD 53K+

Pharmacy Technician Call Center - Remote US
Any city, WI, US, 99999

Gainwell Technologies

Internet usage Pharmacy Knowledge Pharmacist Prior Authorization Processing Call center Operations Pharmacy benefit management Clinical Judgment Prior authorization Messaging +19

USD 30K+

Supervisor, Patient Access and Support
US-Nationwide-FIELD, United States

Cardinal Health Remote-first

Benefit investigations Metrics Reporting Workflow Pay equity Enrollment Prior authorization Standard Operating Procedures Investigations Specialty Pharmacy +28

USD 65K+

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+

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+

Behavioral Health Prior Authorization Manager
REMOTE OPTIONS, PHOENIX

State of Arizona

Medicaid programs Program Planning Health care services Report development Policies and procedures Review Equal Opportunity Provider Relations Eligibility verification +51

USD 83K+

Pharmacist, Clinical Grievance and Appeals
United States

Navitus Health Solutions, LLC

Evidence-based documentation Drug Utilization Review Formulary Development Pharmacy Practice Pharmacy Claims Formulary management Data evaluation Quality review Grievance and appeals +20

USD 98K+

Senior Data Scientist
United States

Cohere Health Remote-first

Causal Analysis Trend Identification Spark SQL Cloud platform Clinical Intelligence Kibana Clinical programs Healthcare Analytics PySpark +31

Senior Full Time

USD 115K+

Medical Director, Operations, Ortho/Spine
United States

Cohere Health Remote-first

Clinical decision guidelines Medical coverage policies Physician training Remote workforce management AI in Healthcare Peer-to-peer discussions Clinical reviews Clinical Intelligence Software tools +23

Exec Senior Full Time

USD 270K+

Senior Actuarial Analyst
United States

Cohere Health Remote-first

Cost savings analysis Claims Data Data Analysis Tools Clinical Strategy Clinical Intelligence Strategic recommendations Athena Model Development Healthcare Analytics +38

Senior Full Time

USD 115K+

Field Reimbursement Specialist
USA - CA - Remote, United States

AmerisourceBergen

Formulary Benefit investigations Specialty distribution Buy and bill Coverage management Educational presentations Pharmacy benefits Patient assistance Reimbursement support +29

USD 86K+

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+

Supervisor, Prior Authorizations
US Remote

GSheets Prior authorizations Call center Operations Insurance Verification Cell-free DNA Collection Healthcare administration Prior authorization Orientation +42

USD 75K+

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