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Utilization management Remote Jobs

96 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+

Provider Relations Field Representative, Dental - Utah
Work From Home - UT, United States

Claims Submission Health Plan Operations Provider Credentialing Provider education Provider Relations Healthcare operations Microsoft Applications Eligibility verification Credentialing +27

USD 44K+

Medical Director - Florida
Remote US

Home health services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Inpatient rehabilitation Post-acute care Clinical group practice management Hospitalist +81

Exec Senior Full Time

USD 223K+

Remote Clinic Triage Registered Nurse - Primary Care
Washington, USA

Jefferson Healthcare

Phone consultations Interventions Health education Triage Clinical assessment Referrals Utilization management

USD 68K+

Part-Time Weekend Medical Director (Remote)
PA, Working at Home - Pennsylvania

Highmark Health

Clinical software General computer Telephone Disease Management Listening Utilization management Oral communication Health Insurance Public health +13

Exec Mid Part Time

USD 170K+

Senior Health Intelligence Programmer
United States - Remote

SSMS Database Programming SSAS AWS Redshift SSRS Query optimization SSIS Healthcare Claims Visual Studio +41

Senior Full Time

USD 70K+

Medical Director, Clinical Strategy, Diagnostic Imaging
United States

Cohere Health Remote-first

Clinical outcomes Content Ideation Healthcare partnerships Clinical program design Software tools Clinical Quality Clinical Strategy Quality Metrics Diagnostic Imaging +27

Exec Senior Full Time

USD 250K+

RN Care Manager
Remote - USA

Clover Health Remote-first

Telephonic Care Coordination Chronic Illness Management Intermediate Computer Healthcare reimbursement Care Plan Development Geriatrics Bilingual (English Electronic Medical Records Discharge planning +11

USD 68K+

Care Manager Behavioral Health - Part Time (Weekends) Remote
PA, Working at Home - Pennsylvania

Highmark Health

Health care services Condition Management Health coaching Utilization management Care management RN Health Insurance Nursing Managed Care +15

USD 50K+

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 Management Clinician (remote in Oregon)
Eugene, OR, US

Culturally competent care Case formulations DSM criteria Substance use Telephonic support Psychosocial assessments Interdisciplinary Teamwork Trauma-Informed Care Bilingual in Spanish +15

Senior Mid Full Time

USD 85K+

Behavioral Health Care Management Clinician (remote in Oregon)
Ontario, OR, US

Culturally competent care Case formulations DSM criteria Substance use Telephonic support Psychosocial assessments Interdisciplinary Teamwork Trauma-Informed Care Bilingual in Spanish +15

Senior Mid Full Time

USD 85K+

Behavioral Health Care Management Clinician (remote in Oregon)
Bend, OR, US

Culturally competent care Case formulations DSM criteria Substance use Telephonic support Psychosocial assessments Interdisciplinary Teamwork Trauma-Informed Care Bilingual in Spanish +15

Senior Mid Full Time

USD 85K+

Behavioral Health Care Management Clinician (remote in Oregon)
PORTLAND, OR, US

Telephonic support Culturally competent care DSM criteria Case formulations Substance use disorder treatment Substance use Psychosocial assessments Interdisciplinary Teamwork Trauma-Informed Care +15

Senior Mid Full Time

USD 85K+

Senior Personal Health Nurse - Remote
United States

Tenet Healthcare

Behavioral Outcomes Milliman care guidelines Healthcare industry expertise Health education Medical management Clinical Documentation Utilization Review Patient Assessment Care Coordination +19

Senior Full Time

USD 72K+

Senior Manager, Network Capacity and Strategy
New York, NY (Remote)

Growth management Network capacity strategy Attrition management Mental health knowledge Provider networks Demand management Strategic Problem Solving Google Slides Therapy +16

Senior Full Time

USD 115K+

Unit Manager Clinical Operations
Downers Grove (3500 Lacey Road)

Health Care Service Corporation

Managed Care Policies Managed Care Knowledge URAC PC Proficiency Clinical Care PC Utilization Review Disease Management Clinical Judgment +22

USD 67K+

Reviewing Medical Director
Remote US

Grievance processes Care facilitation Post-acute services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Post-acute care Inpatient rehabilitation +93

Exec Senior Full Time

USD 199K+

Physician Reviewer, Utilization Management
Remote

Medical necessity criteria Workflow Tools Evidence-Based Guidelines Clinical Review Clinical Acumen Technology Platform Utilization Review Clinical Practice Utilization management +11

Senior Full Time

USD 211K+

Care Coordinator Associate
Working Virtually

MultiCare Health System

Quality issues Financial issues Authorizations Data Platforms Medical Assistant Community Resources Utilization management Nursing Health care +13

USD 44K+

Senior Analyst - Product Management - Work From Home
Work At Home-Arizona

Rally Deadline management Clinical Management Fast-paced Environment Task Management Prior authorization Utilization management Health care Business Analysis +17

Senior Full Time

USD 46K+

UM Administrative Coordinator
Remote US

ICD-10 codes ICD Home Health Electronic Medical Records Utilization Review ICD-10 NLP Prior authorization Authorization +41

Entry Mid Full Time

USD 37K+

Senior Strategy Advancement Professional - Medicaid Capture Management
Remote US

Member Services Long-Term Services and Supports Managed care operations Social determinants Grievance and appeals Healthcare Management Strategy Consulting Articulate Social Determinants of Health +68

Senior Full Time

USD 84K+

Transition Coordinator II (Primary Remote/Hybrid, North Carolina Based)
Morrisville, North Carolina, United States

Alliance Health

Clinical handoffs Care team support Community services Transitional care management Health education Clinical Documentation Medication management Discharge planning Population health +24

USD 66K+

Senior Healthcare Analyst, Actuarial
United States

Cohere Health Remote-first

Cost-Savings Analysis SDOH data Claims Data Athena Data Analysis Tools Healthcare Analytics Clinical Intelligence Model Development Prior authorization +37

Senior Full Time

USD 100K+

Hybrid Field / Remote Inpatient Review Nurse, Clark County, NV (Must have Nevada RN / LVN License)
Las Vegas, Nevada, United States

Alignment Health

Milliman care guidelines Concurrent review Managed Care Plans Medicare managed care plans Medicare Managed Care LVN Community Resources Utilization management Microsoft Outlook +18

USD 74K+

Medical Director - Southeast Region
Remote US

Health claims review Post-acute services Grievance and appeals processes Outpatient services Social determinants Inpatient rehabilitation Commercial health insurance Post-acute care Coding practices +80

Exec Senior Full Time

USD 199K+

Senior Manager, Actuarial- Modeling & Experience Studies
United States

Cohere Health Remote-first

Financial Impact Evaluation Operational analytics Claims Data Healthcare Analytics ROI Analysis Clinical Intelligence Model Development HCPCS Statistical modeling +31

Senior Full Time

USD 165K+

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

Health Care Service Corporation

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

USD 58K+

Medical Director - Gulf South
Remote US

Health claims review Commercial health insurance Outpatient services Grievance and appeals processes Social determinants Hospitalist Clinical group practice management Clinical reference materials Inpatient rehabilitation +81

Exec Senior Full Time

USD 199K+

Behavioral Health Clinical Appeals Reviewer
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

State guidelines Electronic records Grievances Clinical appeals Federal regulations Utilization Review Registered Nurse Detail oriented Utilization management +22

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+

Remote Utilization Management (UM) Coordinator (Long-Term Temporary w/ Medical Benefits)
Remote-US, California, United States

Alignment Health

Referral systems Medicare managed care plans Managed Care Plans Medicare Managed Care CPT codes CPT coding ICD Bilingual (English ICD-10 +17

Entry Temporary

USD 40K+

Primary Nurse Case Administrator I
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Wellness education UM Milliman guidelines Lotus Notes Medical Management Policies CM Coordination of care Database experience Condition Management +31

USD 58K+

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+

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+

Behavioral Analysis Utilization Management Clinical Consultant
Work At Home-Florida

Behavior Analysis Claims review Clinical Practice Guidelines Benefit utilization Benefit management Clinical Guidelines Clinical Criteria Electronic Medical Records Evidence-Based Care +26

USD 52K+

Utilization Management Nurse Consultant - Remote
Work At Home-New York

Navigating multiple systems Benefit utilization Keyboarding Clinical Criteria RN licensure Clinical assessment Registered Nurse Computer Proficiency Utilization management +18

USD 52K+

Genetic Counselor Clinical Reviewer - EviCore - Remote
Florida Work at Home

The Cigna Group

Adult genetics Pediatric genetics Perinatal genetics Genetic counseling Medical Review Health education Clinical Review Utilization Review Genetic Testing +17

USD 69K+

Utilization Management Nurse Consultant- Specialty Medications
Work At Home-Arizona

Clinical documentation systems Clinical Judgement Clinical call center Benefit utilization Phone Benefit management Clinical Criteria Clinical Documentation Prior authorization +17

Senior Mid Full Time

USD 52K+

Utilization Review Nurse - Remote (Select States)
Sentara Health Plans Community Care

Retrospective review Inpatient review Concurrent review Milliman NCQA InterQual Accreditation RN licensure Acute care +20

USD 77K+

Director, Clinical Programs, Diagnostic/Cardiac Imaging
United States

Cohere Health Remote-first

Imaging solutions Clinical optimization Clinical programs Clinical Intelligence AI Technology Radiology Patient outcomes Utilization management Executive Presence +20

Exec Senior Full Time

USD 160K+

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+

Medical Director - Grievances and Appeals
Remote US

Health claims review Rehab Hospitalist Geriatrics Medical background Family practice Medical interpretation Internal Medicine Medical Director +42

Exec Senior Full Time

USD 241K+

Payer Sales Director
United States

Cohere Health Remote-first

Software tools Clinical Intelligence Interoperability Healthcare IT Social Media Marketing Utilization management Clinical expertise Technical sales Healthcare services +11

Exec Senior Full Time

USD 150K+

Clinical Programs Manager
United States

Cohere Health Remote-first

Inpatient acute hospital flows Outpatient patient flows Provider-payer workflows Analytical abilities Clinical programs Clinical Intelligence Client-facing Revenue Cycle Management Healthcare Data +18

USD 115K+

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+

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

Health Care Service Corporation

Wellness education Milliman guidelines UM CM Coordination of care Lotus Notes Medical Management Policies Database experience Condition Management +31

USD 58K+

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+

Clinical Client Training Specialist
Remote, United States

Cohere Health Remote-first

Digital Training Tools Healthcare expertise Remote Team Collaboration User Feedback Client onboarding Clinical Intelligence Training Programs Training delivery Client-facing +12

USD 70K+

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