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Utilization Remote Jobs

48 fresh jobs found

Director, Utilization Management
Remote-OH, United States

Centene Corporation

Ncqa standards Provider experience Healthcare Management NCQA Utilization Medical management Performance Improvement Health Services Training and Development +27

Exec Senior Full Time

USD 124K+

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 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+

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+

Senior LTSS Service Care Manager (RN)
Austin-13620 FM 620 Building C Suite 300 (11121), United States

Centene Corporation

Medicaid health assessments Personalized care plan Member advocacy Service authorization Continuum of care Service plan Quality care Long Term Care Health Assessments +38

Senior Full Time

USD 127K+

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+

Senior LTSS Service Care Manager (RN)
Corpus Christi - 711 N. Carancahua St., Ste 600 (Superior) (10086), United States

Centene Corporation

Rehab Personalized care plan Member advocacy ICU Service authorization Service plan Continuum of care Long Term Care Service coordination +44

Senior Full Time

USD 70K+

Senior LTSS Service Care Manager (RN)
Remote-TX, United States

Centene Corporation

Long-term care planning Medicaid health assessments Community Resource Coordination Personalized care plan Member advocacy Service authorization Service plan Continuum of care Quality care +39

Senior Full Time

USD 127K+

Staff Vice President, Medicare Trend and Strategy
Remote-MO, United States

Centene Corporation

Medicare cost trend analysis Data-driven care models Clinical vendor management Business process excellence Value-Based Care Models Process excellence Population health management Healthcare operations Health management +32

Senior Full Time

USD 182K+

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+

Senior Clinical Analyst
Remote-NY, United States

Centene Corporation

Micro-Strategy Cost and utilization MicroStrategy Healthcare Analytics Utilization Hadoop Reporting tools Trend Analysis Data Mining +33

Senior Full Time

USD 68K+

Authorization Specialist II
Remote-FL, United States

Centene Corporation

Healthcare eligibility Healthcare Policies Authorization processes Authorization requests Insurance coverage Researching Guidelines Adjudication Utilization +19

Entry Mid Full Time

USD 55K+

Senior Data Engineer - IDMC
Remote-MI, United States

Centene Corporation

Cloud Concepts Snowpark Data Staging Data Destruction IDMC Data Provisioning Data Pipeline Optimization Real-time processing Data preparation +50

Senior Mid Full Time

USD 85K+

Network Performance Advisor
Remote-FL, United States

Centene Corporation

Risk contracting Utilization metrics Value-based contracting Network transformation Network performance Quality Metrics Network development Cross-functional Communication HEDIS +28

USD 55K+

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+

Senior Data Engineer
Remote-OH, United States

Centene Corporation

Data Destruction Data Staging Data Provisioning Data Pipeline Optimization C programming Real-time processing Programming concepts Data preparation Microsoft SQL Server +47

Senior Mid Full Time

USD 85K+

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 - 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+

Senior Healthcare Analyst
Remote-PA, United States

Centene Corporation

Micro-Strategy Cost and utilization Healthcare Analytics Utilization Hadoop Reporting tools Trend Analysis Data Mining Financial +32

Senior Mid Full Time

USD 68K+

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+

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+

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+

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+

Authorization Specialist I
Remote-TX, United States

Centene Corporation

Healthcare eligibility Authorization processes Authorization requests Guidelines Utilization Tracking Prior authorization Medical management Referrals +15

Entry Full Time

USD 45K+

Authorization Specialist II
Remote-MO, United States

Centene Corporation

Healthcare eligibility Authorization processes Guidelines Authorization requests Insurance coverage Researching Adjudication Insurance Knowledge Utilization +19

Entry Mid Full Time

USD 55K+

Utilization Review Clinician - Behavioral Health
Remote-FL, United States

Centene Corporation

Guidelines Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Utilization Review +21

USD 52K+

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+

Quality Improvement Coordinator II
Remote-FL, United States

Centene Corporation

Medical record audits Clinical Initiatives Cphq Corrective action plans Healthcare quality Quality of care Utilization Credentialing Medical Records +27

USD 66K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

ABA services Autism spectrum disorder Guidelines Medical appropriateness Behavioral Analysis Healthcare Provider Interaction Clinical Standards Applied Behavior Analysis Treatment plans +29

USD 95K+

Senior Manager, Clinical Operations
Remote-AL, United States

Centene Corporation

Clinical Initiatives Guidelines NCQA Utilization Health outcomes Care Coordination Clinical operations Strategic initiatives Procedures +20

Senior Full Time

USD 119K+

Data Analyst III, Value Based Payment Initiatives
Long Island City - 25-01 Jackson Ave (10936), United States

Centene Corporation

Quality performance analysis Population health management Quality performance Analytical support Health management Project Implementation Healthcare Delivery Health Systems Utilization +32

Senior Mid Full Time

USD 68K+

Utilization Review Clinician-Behavioral Health
Remote-IL, United States

Centene Corporation

Education provision Outpatient Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Utilization Clinical Review Discharge planning +23

USD 52K+

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+

Senior Data Engineer -
Remote-FL, United States

Centene Corporation

Data Staging Data Destruction Data Provisioning Data Pipeline Optimization SSAS Real-time processing SSRS Data preparation Soft +44

Senior Mid Full Time

USD 85K+

Clinical Review Therapist - Physical Health
Remote-TX, United States

Centene Corporation

Therapy regulations Best Practice Standards Therapy Services Healthcare provider collaboration Guidelines Durable Medical Equipment Documentation standards Clinical reviews Clinical Training +20

USD 108K+

Program Manager (Provider Engagement)
Remote-OH, United States

Centene Corporation

Clinical improvements Managed healthcare Value-based contracting Health care operations Provider engagement Risk Adjustment Provider Relations Utilization Health Plan +31

USD 86K+

Senior Market and Operations Manager
Remote-MO, United States

Centene Corporation

Provider experience Community relations Operational reporting Problem identification Operational performance Utilization Provider Relations Healthcare administration Financial Performance +38

Senior Full Time

USD 105K+

Complex Discharge Planner
Remote-FL, United States

Centene Corporation

Prior authorizations Health management systems Health management Medicaid regulations Utilization Discharge planning Needs Assessment Utilization Review Acute care +19

USD 95K+

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+

Senior Data Engineer - IDMC
Remote-MO, United States

Centene Corporation

Data Provisioning Data Pipeline Optimization IDMC Programming concepts Real-time processing Soft Data preparation Informatica Data ingestion +43

Senior Mid Full Time

USD 85K+

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+

Data Analyst III Healthcare Analytics
Remote-MO, United States

Centene Corporation

Microsoft powerbi Large databases Claims pricing Clinical outcomes Data verification Claims payment Utilization Healthcare Analytics Microsoft Power BI +52

Senior Mid Full Time

USD 68K+

Senior LTSS Service Care Manager, RN
Remote-TX, United States

Centene Corporation

Medicaid Assessments Quality care Rehab ICU Continuum of care Service authorization Service coordination Long Term Care Healthcare Education +39

Senior Full Time

USD 70K+

Utilization Review Clinician - Behavioral Health
Remote-NC, United States

Centene Corporation

Education provision Healthcare Collaboration Medical appropriateness Utilization Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review +21

USD 52K+

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+

Provider Engagement Account Manager
Remote-OK, United States

Centene Corporation

Cost and utilization Network performance Quality measures Utilization Provider education Provider engagement HEDIS Provider Relations Health Plan +28

USD 55K+

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+

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+

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