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186 fresh jobs found
Utilization Management Review Nurse
Remote US, United States Humana logo Humana
Interpreting Criteria Health Plan Experience Clinical Nursing Rehabilitation Medical Services Health outcomes Acute care Consumer Experiences Registered Nurse +46
Mid Full Time
USD 71K+
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Case Manager RN
Work At Home-Virginia, United States CVS Health logo CVS Health
Home health care coordination Proprietary applications Home health care RN license Navigating multiple systems RN licensure Keyboarding Home Health Clinical Practice +25
Mid Full Time
USD 60K+
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Clinical Review Clinician - Appeals (RN)
Remote-TX, United States Centene Corporation logo Centene Corporation
Clinical data analysis Appeals processing Interdepartmental Collaboration Clinical reviews Ncqa standards Medicaid regulations Clinical Review Appeals Medical necessity +18
Mid Full Time
USD 95K+
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Care Manager (RN)
Remote-NJ, United States Centene Corporation logo Centene Corporation
Service planning Home outreach Resource support Personalized care plans Digital Outreach Service Assessment Foster care Healthcare outcomes Service plans +22
Mid Full Time
USD 55K+
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Clinical Review Nurse - Concurrent Review (RN)
Remote-TX, United States Centene Corporation logo Centene Corporation
NICU experience Health management systems Health management Medicaid regulations Clinical Review Acute care Discharge planning Medical necessity Medical Records +16
Mid Full Time
USD 95K+
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Prior Authorization Clinician RN
Work At Home-Oklahoma, United States CVS Health logo CVS Health
Precertification Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +18
Mid Full Time
USD 52K+
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Primary Nurse Case Admin I ONSITE - Dallas
Richardson Texas HQ (1001 E. Lookout Drive), United States Health Care Service Corporation logo Health Care Service Corporation
Wellness education Milliman guidelines Coordination of care Lotus Notes Medical Management Policies UM CM Database experience Condition Management +34
Mid Full Time
USD 60K+
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Senior Behaviorial Health Program Manager
Remote-MI, United States Centene Corporation logo Centene Corporation
Managed care experience Corrective action plans Health management Clinical Criteria Workflow Design Provider education Psychology Health education Clinical Training +29
Senior Full Time
USD 86K+
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Clinical Specialist I, CPT - Boise
United States of America : Remote Abbott logo Abbott
Chronic Pain Therapies Sales strategy development Programming assistance Clinical Setting Medical training Competitor Analysis Technical certification Implantable devices Interventional Pain Therapy +37
Mid Full Time
USD 60K+
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Health Coach - Wellness
Remote-OK, United States Centene Corporation logo Centene Corporation
Telephonic assessments Wellness Programs Chronic Condition Management Care Plan Development Accreditation Standards Compliance Documentation Care Plans Accreditation Health coaching +15
Mid Full Time
USD 95K+
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Quality Improvement Abstractor
Remote-TN, United States Centene Corporation logo Centene Corporation
CHIPRA Quality Initiatives Quality measures Data Abstraction Ncqa standards Microsoft Applications HEDIS Medical Coding Microsoft Access +17
Mid Full Time
USD 95K+
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Primary Nurse Case Admin I ONSITE
Richardson Texas HQ (1001 E. Lookout Drive), United States Health Care Service Corporation logo Health Care Service Corporation
Wellness education Milliman guidelines Medical Management Policies CM UM Database experience Condition Management Coordination of care Lotus Notes +34
Mid Full Time
USD 60K+
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Clinical Sales Specialist, Structural Heart, TAVI (Las Vegas)
United States of America : Remote Abbott logo Abbott
3D Imaging CT Program Valve sizing analysis CT Valve Sizing 3mensio CT Program TAVI products Internal training Echocardiography Commercial case support +50
Mid Full Time
USD 75K+
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Clinical Specialist I
United States of America : Remote Abbott logo Abbott
Chronic Pain Therapies Sales strategy development Programming assistance Clinical Setting Patient interaction Technical certification Medical training Competitor Analysis Implantable devices +37
Mid Full Time
USD 60K+
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Community Liaison
Remote-LA, United States Centene Corporation logo Centene Corporation
Outreach coordination Substance use Accreditation Community Health Substance Use Disorder Social services Social Work Community Engagement Stakeholder communication +33
Mid Full Time
USD 55K+
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Quality Improvement Coordinator I
Remote-WA, United States Centene Corporation logo Centene Corporation
Clinical Quality Quality of care Healthcare Management HEDIS Medical Records Performance Improvement Performance monitoring Utilization management Quality improvement +16
Mid Full Time
USD 95K+
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Utilization Management Nurse Consultant
Work At Home-Michigan, United States CVS Health logo CVS Health
CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20
Entry Mid Full Time
USD 58K+
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Quality Improvement Coordinator - Behavioral Health
Remote-WA, United States Centene Corporation logo Centene Corporation
Clinical Nursing Grievances Quality of care Clinical Quality Program Evaluation Healthcare administration Appeals HEDIS Medical necessity +19
Mid Full Time
USD 66K+
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RN Complex Care Manager (Remote)
Silver Spring, MD, United States Trinity Health logo Trinity Health
Health records Chronic Conditions Health risk assessment Evidence-Based Guidelines Clinical Nursing Electronic Health Records Patient Education Diversity and Inclusion RN +10
Mid Full Time
USD 76K+
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Clinical Review Nurse - Prior Authorization
Getzville-105 Crosspoint Pkwy (11106), United States Centene Corporation logo Centene Corporation
Clinical reviews Authorization requests Health management Health management systems Medical appropriateness Medicaid regulations Clinical Review Medical necessity Acute care +18
Mid Full Time
USD 95K+
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Behavioral Health Clinical Liaison
Remote-FL, United States Centene Corporation logo Centene Corporation
Outpatient Treatment plans Substance use Substance abuse Provider education Clinical assessment Procedures Treatment Planning Health Services +28
Mid Full Time
USD 68K+
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Pediatric Hospital Sales Specialist - Northeast Ohio
United States of America : Remote Abbott logo Abbott
Hospital Negotiations Promotion Nutrition Products Hospital Setting Pediatrics Product Launches Nutrition Clinical Studies Medical science +19
Mid Full Time
USD 60K+
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Clinical Review Nurse - Concurrent Review
Remote-NY, United States Centene Corporation logo Centene Corporation
Health management Health management systems Medicaid regulations Clinical Review Medical necessity Acute care Discharge planning Health Services Medical Records +15
Mid Full Time
USD 52K+
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Utilization Management Nurse Consultant
Work At Home-Kansas, United States CVS Health logo CVS Health
CM/UM certification IT platforms Med/surg Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Clinical Judgment +20
Entry Mid Full Time
USD 52K+
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Supervisor, Utilization Management
Remote-NC, United States Centene Corporation logo Centene Corporation
Regulations knowledge UM Accreditation Standards Accreditation Clinical Review Procedures Health Services Prior authorization Medical management +17
Mid Full Time
USD 73K+
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Process Improvement Specialist (Clinical)
Remote-LA, United States Centene Corporation logo Centene Corporation
Clinical Initiatives Quality measures Clinical outcomes Service coordination Health outcomes HEDIS Disease Management Project Coordination Health Services +17
Mid Full Time
USD 68K+
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Appeals Nurse Consultant (Remote)
Work At Home-Delaware, United States CVS Health logo CVS Health
Computer systems navigation Drg experience Medicare guidelines Appeals experience RN licensure Appeals Medical necessity Typing Utilization management +13
Mid Full Time
USD 60K+
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Clinical Sales Specialist, Structural Heart, TAVI (Tucson, AZ)
United States of America : Remote Abbott logo Abbott
CT Program Endovascular Valve sizing analysis Internal training CT Valve Sizing TAVI products 3mensio CT Program Echocardiography Commercial case support +50
Mid Full Time
USD 75K+
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Clinical Sales Specialist, Structural Heart, TAVI (Dallas, TX)
United States of America : Remote Abbott logo Abbott
CT Program Endovascular Echo Imaging 3D Imaging 3mensio CT Program TAVI products Internal training CT Valve Sizing Valve sizing analysis +51
Senior Mid Full Time
USD 75K+
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Clinical Review Nurse - Prior Authorization
Remote-TX, United States Centene Corporation logo Centene Corporation
Clinical reviews Health management Authorization requests Medical appropriateness Health management systems Medicaid regulations Clinical Review Medical necessity Prior authorization +17
Mid Full Time
USD 95K+
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Utilization Management Nurse Consultant
Work At Home-Illinois, United States CVS Health logo CVS Health
Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication Medical necessity +25
Mid Full Time
USD 64K+
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RN- Field Nurse Home Based Care, Birmingham, AL
Alabama Work at Home, United States The Cigna Group logo The Cigna Group
Telephonic support Health Assessments Client-facing Home Health Social Determinants of Health Medication management Health Services Care Coordination Patient Education +13
Mid Full Time
USD 76K+
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Behavioral Health Care Coordinator
Richardson Texas HQ (1001 E. Lookout Drive), United States Health Care Service Corporation logo Health Care Service Corporation
Contract Interpretation Database experience Clinical Review PC Medical necessity Utilization Review Registered Nurse Database Clinical Experience +13
Mid Full Time
USD 60K+
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Case Manager- Sheboygan and Ozaukee Counties
Work at Home - Wisconsin, United States Humana logo Humana
Health and Wellness Coordination Driver safety program Social service care management Community integration Family Care Prevention Social services Health and wellness Human services +39
Mid Full Time
USD 53K+
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Care Manager - Behavioral Health Peds
Remote-KS, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Substance Use Disorders Treatment options Personalized care plans Compliance Documentation Substance use Care Plans Home visits Digital Outreach +24
Mid Full Time
USD 55K+
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LTSS Service Care Manager
Remote-HI, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Member education Quality of care Long Term Care Healthcare Provider Interaction Care Plans Resource support Service plans Foster care +15
Mid Full Time
USD 95K+
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Case Manager- Weston, WI
Work at Home - Wisconsin, United States Humana logo Humana
Driver safety program Healthcare Coordination Social service care management Community integration Family Care Prevention Social services Health and wellness Human services +39
Mid Full Time
USD 53K+
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Senior Care Manager
Remote-NY, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Substance Use Disorders Service coordination Treatment options Care Plans Substance use Home visits Service plans Healthcare Coordination +29
Senior Full Time
USD 72K+
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Care Manager (RN) Bergen and Passaic County
Remote-NJ, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Personalized care plans Care Plans Resource support Digital Outreach Service plans Service Assessment Foster care Healthcare benefits +19
Mid Full Time
USD 55K+
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Prior Authorization Utilization Review - PASRR (Remote Nurse)
Any city, KS, US, 99999 Gainwell Technologies logo Gainwell Technologies
Functions Utilization Review Claims Clinical expertise RN Case Management Nursing Medicaid Medical +18
Mid Full Time
USD 65K+
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Primary Nurse Case Admin l - TX
Richardson Texas HQ (1001 E. Lookout Drive), United States Health Care Service Corporation logo Health Care Service Corporation
Wellness education Lotus Notes Coordination of care Milliman guidelines Medical Management Policies UM CM Database experience Condition Management +33
Mid Full Time
USD 60K+
Preview Apply
Clinical Sales Specialist, Structural Heart, TAVI (Baltimore)
United States of America : Remote Abbott logo Abbott
CT Program Endovascular Proctoring Cardiac surgery Clinical trial support CT Valve Sizing 3mensio CT Program TAVI products Valve sizing analysis +55
Mid Full Time
USD 75K+
Preview Apply
Care Manager (RN)
Remote-MS, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Personalized care plans Compliance Documentation Care Plans Resource support Digital Outreach Service plans Foster care Service Assessment +20
Mid Full Time
USD 55K+
Preview Apply
Clinical Specialist I, CPT - Pittsburgh, PA
United States of America : Remote Abbott logo Abbott
Chronic Pain Therapies Programming assistance Clinical Setting Technical certification Patient interaction Medical training Competitor Analysis Implantable devices Interventional Pain Therapy +36
Mid Full Time
USD 60K+
Preview Apply
LTSS Service Care Manager - Behavioral Health
Remote-TX, United States Centene Corporation logo Centene Corporation
Healthcare outcomes Service coordination Treatment options Quality of care Care Plans Substance use Service plans Service Assessment Foster care +26
Mid Full Time
USD 52K+
Preview Apply
Clinical Sales Specialist, Structural Heart, TAVI (Nashville)
United States of America : Remote Abbott logo Abbott
CT Program Endovascular Clinical trial support Internal training TAVI products Valve sizing analysis CT Valve Sizing 3mensio CT Program Echocardiography +51
Mid Full Time
USD 75K+
Preview Apply
Supervisor, Care Management
Remote-WI, United States Centene Corporation logo Centene Corporation
Member Outreach Team Supervision Healthcare benefits Performance Evaluation Referrals Procedures Care Coordination Audits Care management +15
Mid Full Time
USD 85K+
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Clinical Sales Specialist, Structural Heart, TAVI (DC / North Virginia)
United States of America : Remote Abbott logo Abbott
CT Program Endovascular Clinical trial support Internal training TAVI products Valve sizing analysis CT Valve Sizing 3mensio CT Program Echocardiography +51
Mid Full Time
USD 75K+
Preview Apply
Clinical Sales Specialist, Structural Heart, TAVI (Louisville, KY)
United States of America : Remote Abbott logo Abbott
Endovascular CT Program CT Valve Sizing 3mensio CT Program TAVI products Valve sizing analysis Internal training Echocardiography Commercial case support +49
Mid Full Time
USD 75K+
Preview Apply
Clinical Specialist I, CPT - Ithaca, NY
United States of America : Remote Abbott logo Abbott
Chronic Pain Therapies Programming assistance Clinical Setting Technical certification Patient interaction Medical training Competitor Analysis Implantable devices Interventional Pain Therapy +36
Mid Full Time
USD 60K+
Preview Apply
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