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Utilization management Remote Jobs

79 fresh jobs found

RN Case Manager - Kentucky
KY - Remote

Ambulatory care Community public health Insurance Setting Home health care Medication Reconciliation Interdisciplinary Teamwork Geriatric care Patient advocacy Clinical Care +12

USD 90K+

Director, Analytics & Insights
United States

Cohere Health Remote-first

Clinical programs Qualitative methods LOINC SNOMED Clinical Informatics Quantitative methods Clinical Intelligence Model Development HCPCS +30

Exec Senior Full Time

USD 155K+

Cigna Medicare Clinical Operations Program Management Lead Analyst- Remote- Cigna Healthcare
Tennessee Work at Home

The Cigna Group

Medicare Advantage Data Validation Utilization management Clinical operations Data integrity Nursing Influencing Auditing Behavioral health +25

Senior Mid Full Time

USD 74K+

UM Administration Coordinator (Kentucky Medicaid)
Work at Home - Kentucky

ICD-10 codes ICD Electronic Medical Records Utilization Review ICD-10 Prior authorization Authorization Utilization management Travel +41

USD 37K+

Senior Risk Management Professional
Remote US

Risk Utilization management Collaborative Clinical operations BI Vision Dental Healthcare services Nursing +37

Senior Mid Full Time

USD 76K+

RN II, Primary Nurse Care (Oncology)
Hopewell, NJ

Horizon Blue Cross Blue Shield of New Jersey

Oncology Care Health Care Delivery Patient advocacy Clinical assessment Utilization management Quality improvement RN Care management Telehealth +1

USD 76K+

RN Case Manager - New York
NY - Remote

Community public health Ambulatory care Home health care Insurance Setting Medication Reconciliation Interdisciplinary Teamwork Geriatric care Patient advocacy Clinical Care +11

USD 85K+

Clinical Advisor - Specialty Strategic Account Executive (Pharmacist)
Work At Home-Texas

Pharmacy experience Formulary management Client Strategy Benefit management Pharmacy benefit management Specialty Pharmacy Pharmaceuticals Utilization management Pharmacy +15

Exec Mid Full Time

USD 100K+

Reimbursement Business Manager - Dermatology (Houston Metro, TX)
Remote - United States

Payer landscape Healthcare provider support Reimbursement management Matrix Environment Dermatology Specialty Pharmacy Clinical Documentation Biologics Pharmaceuticals +6

USD 163K+

UM Nurse-Compact RN License Required
Remote US

Interpreting Criteria Medical Services Health Plan Experience Clinical Nursing Home Health Rehabilitation Acute care Registered Nurse Consumer Experiences +37

USD 69K+

Utilization Management Behavioral Health Professional
Work at Home - Kentucky

Substance Use Knowledge Interpreting Criteria Medical Services Social service agencies Health promotion Human services Community Health Utilization Review Community Resources +44

USD 63K+

Personal Health Nurse - Remote
United States

Tenet Healthcare

Email proficiency Personal health management Healthcare industry expertise Cost Containment Medical management Utilization Review Utilization management Health care Prioritization +16

USD 64K+

Patient Care Coordinator - Remote
United States

Tenet Healthcare

Cultural Competence Healthcare industry expertise Medical management Utilization management Managed Care Health care Coordination Case Management Medicare +18

Entry Mid Full Time

USD 51K+

Utilization Management (UM) Nurse - Pre-Service (Must have RN / LVN California Licensure)
Remote-US, California, United States

Alignment Health

Referral System Proficient Computer California licensure Medicare managed care plans Medicare Managed Care Managed Care Plans CPT codes Milliman guidelines ICD +28

USD 74K+

UM Administration Coordinator
Remote US

ICD-10 codes ICD Electronic Medical Records Utilization Review ICD-10 Prior authorization Authorization Utilization management Clinical support +41

Entry Mid Full Time

USD 37K+

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+

Senior Business Analyst (Clinical)
United States - Remote

Client Liaison Workflow Diagrams Implementations Clinical Solutions Requirements Management Clinical assessments Gap Analysis Public Sector Business Requirements +23

Senior Full Time

USD 85K+

Dental Reviewer, Supervisor (Remote within Arkansas)
Arkansas, United States - Remote

Dental review Web navigation Dental hygiene Strong organizational Medical record abstracting Human services Clinical Review Clinical assessment Public Sector +21

Senior Mid Full Time

USD 71K+

Sales Executive - Payer
San Mateo, CA

HEDIS Innovation in healthcare Value-based care Member engagement Risk Adjustment Utilization management Enterprise Sales Healthcare industry Cloud Infrastructure +9

Exec Senior Full Time

USD 150K+

Nurse Manager, Quality of Care
Remote

Evidence-based resources Clinical performance Milliman care guidelines Quality Auditing Quality of care Operational performance Appian Ticketing Systems Triage +34

USD 108K+

Medical Director - Northeast Region
Remote US

Commercial health insurance Post-acute services Grievance and appeals processes Outpatient services Coding practices Clinical group practice management Judgement Inpatient rehabilitation Hospitalist +80

Exec Senior Full Time

USD 199K+

Utilization Review RN - Remote
Home Office: Birmingham, AL

Payer regulations Managed care trends Coding terminology Medical necessity reviews Clinical terminology Clinical Guidelines Medical Records Utilization management Productivity +20

Senior Mid Full Time

USD 86K+

Clinical Investigation Lead
Remote US

Health systems operations Healthcare claims data Healthcare Claims Medical claims Business Insights Clinical Strategy Health outcomes Healthcare operations Medical Coding +48

Senior Full Time

USD 112K+

Lead Research Scientist
Remote US

Spark/Scala Spark r Recommender Systems Clinical Informatics Claims analysis Business Insights Healthcare Delivery Health outcomes Network Analysis +67

Senior Mid Full Time

USD 123K+

Clinical Training and Quality Specialist
United States

Cohere Health Remote-first

Adult Learning Theory Clinical Intelligence RN licensure Clinical Training Performance Reporting Prior authorization Utilization management Quality improvement RN +10

Senior Mid Full Time

USD 70K+

State Hospital Liaison
Spokane, Washington, United States

Community Health Plan of Washington

Substance use disorder treatment Workflow systems Care management workflow systems Chemical dependency Community Resources Discharge planning Psychology Social Work Care Coordination +14

Senior Mid Full Time

USD 83K+

Medical Director - National Medicare Team
Remote US

Commercial health insurance Project team participation Managed Care Knowledge Clinical Standards Clinical group practice management Humana policies Medical interpretation Medical background National Guidelines +42

Exec Senior Full Time

USD 199K+

Case Manager RN
Work At Home-Colorado

Transplant Critical care RN license RN licensure Clinical Practice Utilization management RN Managed Care Health care +8

USD 60K+

UM Nurse Consultant-Reconsideration
Work At Home-Arizona

Clinical call center Clinical Judgement Benefit utilization Benefit management Long Term Care Clinical Criteria Home Health Acute care Call Center Experience +19

USD 52K+

Medical Director- South Central
Remote US

Post-acute services Clinical group practice management Clinical Standards Grievance and appeals processes Outpatient services Coding practices Inpatient rehabilitation Medical background Clinical reference materials +78

Exec Senior Full Time

USD 199K+

State Hospital Liaison
Seattle, Washington, United States

Community Health Plan of Washington

Substance use disorder treatment Chemical dependency Care management workflow systems Workflow systems Community Resources Discharge planning Psychology Social Work Care Coordination +14

Senior Mid Full Time

USD 83K+

Business Development Representative
United States

Cohere Health Remote-first

Sales Engagement Social Media Outreach Clinical Intelligence Email Campaigns Prior authorization Utilization management Healthcare Technology Clinical expertise Cold Calling +16

Entry Mid Full Time

USD 75K+

Utilization Management Liaison Lead
Remote

Insurance experience Workflow improvement Clinical Review Performance Indicators Lean Six Sigma Technology Platform Administrative Tasks KPIs Utilization management +24

Senior Mid Full Time

USD 48K+

Utilization Management Clinical Consultant
Work At Home-West Virginia

Healthcare services coordination Clinical Practice Guidelines Benefit utilization Benefit management Navigating multiple systems Clinical Criteria Keyboarding Clinical Practice Utilization Review +26

USD 52K+

Director Market Access Operations (Remote)
Remote

Otsuka Pharmaceutical Companies

Formulary access management Payer markets Budget reporting Microsoft Tools Matrix management Pharmaceutical products Impactful Communication Pharmaceutical Development Learning agility +24

Exec Senior Full Time

USD 160K+

Utilization Management Nurse Consultant
Work At Home-Arizona

Evidence-based clinical criteria Clinical documentation systems Clinical call center Clinical Practice Guidelines Clinical Judgement Phone Long Term Care Navigating multiple systems Clinical Criteria +22

USD 52K+

UM Nurse Consultant (Remote)
Work At Home-Ohio

Coverage determination Benefit utilization Benefit management Navigating multiple systems Clinical Criteria RN licensure Keyboarding Registered Nurse Clinical Judgment +17

USD 52K+

Primary Nurse Case Admin I - CM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Medical Management Policies Condition Management Database experience Lotus Notes Coordination of care +29

USD 58K+

Primary Nurse Case Admin I - UM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Medical Management Policies Condition Management Database experience Coordination of care PC Proficiency +27

USD 58K+

Medical Director - Acute Rehab Team
Remote US

Acute inpatient rehabilitation Humana policies Clinical reference materials Medical interpretation Medical background CMS policies Hospitalist Inpatient rehabilitation National Guidelines +52

Exec Senior Full Time

USD 199K+

Dental UM Supervisor (Remote within Arkansas)
Little Rock, AR, United States

Dental hygiene Medical record abstracting Internet navigation Clinical Review Clinical assessment Utilization management Clinical expertise MS Office Critical thinking

Senior Mid Full Time

USD 71K+

Medical Director - Pharmacy Appeals
Remote US

Medicare rules Clinical group practice management Humana policies National Guidelines CMS policies Rules InterQual MCG Medical Director +51

Exec Senior Full Time

USD 199K+

Utilization Management Administrative Support
Work From Home - AZ

Microsoft Applications Accuracy Utilization management Leadership Development Confidentiality SharePoint Microsoft Teams Data Entry Outlook +9

Entry Mid Full Time

USD 41K+

Clinical Documentation Integrity Peds Specialist
Fully Remote

Graphical analysis Medical information interpretation Database programs Coding clinic 3M 360 Encompass CAC 3M 360 Encompass Abstracting Medical record documentation Coding Guidelines +18

Senior Full Time

USD 92K+

Care Coordinator Associate - Post Acute
Working Virtually

MultiCare Health System

Quality issues Financial issues Authorizations Data Platforms Medical Assistant Community Resources Utilization management Nursing Health care +12

USD 44K+

Operating Effectiveness Senior Analyst - eviCore - Remote
Tennessee Work at Home

The Cigna Group

Pathway designer Clinical knowledge integration Adobe Pro DITA Call center Operations Clinical Review Health Services Software Applications Regulatory standards +31

Senior Mid Full Time

USD 60K+

AVP, Clinical Operations Cost of Care Strategy
Remote US

Policy Optimization Operational analytics Health Plan Experience Healthcare economics Functions Strategic direction Prior authorization Analytic Authorization +52

Exec Senior Full Time

USD 181K+

UM Administration Coordinator (Intermountain Region)
Work at Home - Utah

Telephonic Customer Service ICD-10 codes Electronic Medical Records ICD Utilization Review Prior authorization ICD-10 Healthcare experience Consumer Experiences +42

Entry Full Time

USD 37K+

Clinical Documentation Integrity Specialist
Fully Remote

3M 360 Encompass CAC Abstracting Medical Information 3M 360 Encompass Abstracting Interdisciplinary Teamwork Medical record documentation Medical Coding Computer Proficiency Clinical Documentation +13

Senior Full Time

USD 92K+

Primary Nurse Case Admin l UM - TX
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

UM CM Wellness education Milliman guidelines Condition Management Medical Management Policies Lotus Notes Database experience Coordination of care +29

USD 58K+

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