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Utilization management Remote Jobs

163 fresh jobs found

Utilization Management Clinical Care Reviewer II - MUST be Multi-State Licensed
Mississippi WFH, United States

Clinical care review Proper grammar usage Medical Necessity Review Registered Nursing Phone Etiquette Provider engagement Discharge planning Accreditation Certification +33

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+

Clinical Review Nurse - Concurrent Review
Remote-NC, United States

Centene Corporation

Health management systems Medicaid regulations Health management Utilization Clinical Review Medical necessity Acute care Discharge planning Medical Records +19

USD 52K+

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+

Nurse Care Manager - Sign On Bonus
Remote

Evergreen Nephrology

Comprehensive care plans Telephonic Triage RN license Transitions of Care Evidence-Based Guidelines Emotional support Chronic Condition Management Healthcare Delivery Care Planning +17

USD 103K+

Senior Manager, Client Success, Value Based Care
United States

Cohere Health Remote-first

Clinical Workflows Clinical Intelligence Interoperability Client onboarding Client Experience Solutions Architecture Value-based care Client Success Digital Health +23

Senior Full Time

USD 110K+

Care Manager RN (Delaware) Remote
PA, Working at Home - Pennsylvania, United States

Highmark Health

Medical Policies Health care services Health coaching Clinical Experience Utilization management RN Care management Managed Care Nursing +16

USD 50K+

Authorization Specialist I
Remote-NY, United States

Centene Corporation

Authorization processes Healthcare eligibility Utilization Authorization requests Prior authorization Referrals Medical management Health Services Utilization management +13

Entry Full Time

USD 45K+

Behavioral Health Service Mgr-BH Medication Monitoring
Remote-OK, United States

Centene Corporation

Behavioral health services Mental health resources Utilization Data Monitoring Clinical Nursing Quality of care Foster care Evidence-based practices Discharge planning +32

USD 95K+

Clin Ops Educ & Excell Coord (UM focus) (Trainers)
Mississippi WFH, United States

Clinical documentation systems Proper grammar usage LSW Phone Etiquette Adult Learning Certification Performance Improvement Clinical Experience Clinical operations +35

USD 55K+

Case Manager- Out of Network Management- System Services- Remote -Full Time- Days
System Services-Telecommuter, United States

Sharp HealthCare

Health plan criteria MCG Clinical Nursing Healthcare Coordination InterQual Patient Assessment Utilization Review Utilization management Consultation +6

USD 60K+

Sr. Nurse Reviewer - Provider Relations
Any city, MA, US, 99999

Gainwell Technologies

Interqual criteria Prepayment review Pre-admission screening Post payment review RN license InterQual Processes Provider Relations Clinical Review +30

Senior Full Time

USD 64K+

Clinical Review Nurse - Concurrent Review
Remote-IN, United States

Centene Corporation

Utilization Health management systems Medicaid regulations Health management Medical necessity Clinical Review Acute care Discharge planning Medical Records +19

USD 95K+

Quality Improvement Coordinator I
Remote-WA, United States

Centene Corporation

Utilization Clinical quality improvement Healthcare quality Clinical Quality HEDIS Quality of care Healthcare Management Medical Records Performance Improvement +22

USD 95K+

Provider Engagement Account Executive
Remote-OK, United States

Centene Corporation

Value-based performance Utilization Cost and utilization Interpersonal relationships Quality measures HEDIS Health administration Provider engagement Network management +37

Exec Mid Full Time

USD 86K+

Field Reimbursement Specialist - San Francisco, CA
US - California - Thousand Oaks - Field/Remote, United States

Collaborative territory strategic plan Insurance forms Budgets Formulary coverage Reimbursement process Financial assistance programs Payer prior authorization Patient health information Benefits investigation +53

USD 155K+

Clinical Review Nurse - Prior Authorization
Remote-FL, United States

Centene Corporation

Utilization Medicare regulations Cost-effective care Service authorization Health management systems Medicaid regulations Health management Authorization requests Medical appropriateness +26

USD 52K+

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+

Remote PRN Medical Director - Missouri
Remote-MO, United States

Centene Corporation

Clinical quality improvement Pediatrics Health financing Clinical programs Personnel management Clinical Quality Medical Review Health administration Medical Services +24

Exec Mid Part Time

USD 212K+

HMSA Intake Precert Care Manager - Remote Hawaii
Remote HI Honolulu 96813, United States

Magellan Health Remote-first

DSM V Telephone triage Clinical reviews Substance abuse Discharge planning Outpatient Care Triage Tracking Crisis Intervention +17

USD 58K+

Medical Director - Gulf South
Remote US, United States

Post-acute services Grievance and appeals processes Community Groups Outpatient services Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +88

Exec Senior Full Time

USD 223K+

Grievance & Appeals Coordinator I
Burr Ridge - 1333 Burr Ridge Pkwy, Ste 125 (10938), United States

Centene Corporation

Claims research Utilization Grievance Grievances Managed care experience HEDIS Appeals Medical management Health Services +14

Entry Mid Full Time

USD 64K+

Medical Director - Mid West Region
Remote US, United States

Computer-Based Review Community Groups Outpatient services Grievance and appeals processes Inpatient rehabilitation Commercial health insurance Clinical group practice management Post-acute care Humana policies +83

Exec Senior Full Time

USD 223K+

Payer Solutions Inpatient UM Case Management Lead Analyst - Evernorth Health Services - Remote
Minnesota Work at Home, United States

The Cigna Group

Chemical dependency Health care services Technology systems Treatment plans Medical necessity Discharge planning Behavioral healthcare Utilization Review Conflict Management +25

Senior Mid Full Time

USD 65K+

Data Analyst III Healthcare Analytics
Remote-FL, United States

Centene Corporation

Clinical outcomes Claims payment Data verification Microsoft Power BI Healthcare Analytics Risk Adjustment Actuarial Actuarial science Healthcare administration +46

Senior Mid Full Time

USD 68K+

Behavioral Health Medical Director - Medicaid
Remote US, United States

Computer-Based Review CGX Community Groups Clinical reference materials CMS policies Medical background MCG Medical Director Clinical evaluation +48

Exec Senior Full Time

USD 223K+

Data Analyst II Medical Economics
Remote-FL, United States

Centene Corporation

Claims pricing Clinical outcomes Claims payment Data verification Contract Analysis Healthcare Analytics Risk Adjustment Actuarial Actuarial science +44

USD 55K+

Payer Strategy Director
United States

Cohere Health Remote-first

Claims Data Clinical Intelligence Clinical programs Client Experience Interoperability Value-based care Health Technology Creative Problem Solving Digital Health +22

Exec Senior Full Time

USD 175K+

Nurse Care Manager - Chronic & Complex Care Management
Remote

Evergreen Nephrology

Patient care management Care Plan Development Emotional support Interdisciplinary Collaboration Healthcare Delivery Patient Engagement Telephony Chronic care management Social Determinants of Health +14

USD 90K+

Senior Actuarial Manager
United States

Cohere Health Remote-first

Enterprise data warehouse Utilization Analysis Cost-Savings Analysis Claims Data Actuarial modeling Clinical Intelligence Healthcare Analytics Pricing strategies Model Development +36

Senior Full Time

USD 165K+

Provider Engagement Account Manager (BH Exp)
Remote-MS, United States

Centene Corporation

Cost and utilization Network performance Quality measures Provider education Provider engagement HEDIS Health Plan Provider Relations Issue Resolution +26

USD 55K+

Staff Vice President PHCO UM Operations Support
Remote-MO, United States

Centene Corporation

UM Operations support Project Execution Healthcare administration Clinical operations Stakeholder Collaboration Operations Management Utilization management Procedures +16

Senior Full Time

USD 182K+

Medical Director- South Central
Remote US, United States

Community Groups Outpatient services Grievance and appeals processes Post-acute services Clinical group practice management Inpatient rehabilitation Post-acute care Commercial health insurance Humana policies +86

Exec Senior Full Time

USD 223K+

Medical Director - Pacific SW
Remote US, United States

Health claims review Community Groups Outpatient services Grievance and appeals processes Clinical group practice management Commercial health insurance Inpatient rehabilitation Post-acute care Humana policies +84

Exec Senior Full Time

USD 223K+

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

Health Care Service Corporation

CM Medical Management Policies Standardized Criteria Milliman guidelines Database experience Ancillary services Condition Management UM Coordination of care +35

USD 60K+

Behavioral Health Care Manager Remote, must be Licensed and Reside in California
Remote CA San Diego 92126, United States

Magellan Health Remote-first

Inpatient care DSM-5 DSM V Telephone triage Clinical reviews Substance abuse Discharge planning Outpatient Care Triage +19

USD 58K+

Psychologist Reviewer
Remote-SC, United States

Centene Corporation

Education on best practices Diagnostic evaluations Outpatient Psychological testing Peer reviews Substance abuse Clinical Information Clinical Psychology Psychology +18

USD 84K+

Clinical Review Nurse - Prior Authorization
Remote-NY, United States

Centene Corporation

Service authorization Health management systems Health management Medicaid regulations Authorization requests Medical appropriateness Clinical reviews Clinical Information Clinical Review +21

USD 95K+

Remote Beahvioral Medical Director - Kentucky
Remote-KY, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Health care quality Medical management programs Health financing Provider network development Government programs Clinical Quality Medical Review +39

Exec Mid Full Time

USD 231K+

Clinical Review Nurse - Concurrent Review
Remote-MN, United States

Centene Corporation

RN licensure Health management systems UM Medicaid regulations Health management InterQual Acute care Discharge planning Clinical Review +22

USD 52K+

Sr. Director Formulary Management- REMOTE
Home, United States

Prime Therapeutics

Clinical program implementation Consultative methods Clinical analysis Formulary management Employee Development Prior authorization Client Relations Employee Relations Utilization management +17

Senior Full Time

USD 143K+

Care Worker
Remote CA San Diego 92108, United States

Magellan Health Remote-first

Chronic pain management Psychiatric terminology Health promotion Disease Management Tracking Care Coordination Community Resources Utilization management Clinical support +11

USD 37K+

Telephonic Nurse Case Manager
HGB SCA Remote PA, United States

Holistic approach Tricare MCG Evidence-based medicine Clinical Nursing Medical Services Accreditation Motivational interviewing Utilization Review +45

USD 71K+

Senior Analyst, Network Analytics
Remote

Medical economics Payment Integrity Quality of care Models Healthcare Analytics Technology Platform Contract negotiations Network Operations Risk Adjustment +32

Senior Mid Full Time

USD 72K+

Utilization Mgmt Spec RN-3
Working Virtually, United States

MultiCare Health System

Chart documentation Insurance Industry Knowledge Guidance Clinical Experience Insurance Industry Utilization management Judgment Authorization Health care +12

Senior Full Time

USD 98K+

Payment Integrity Clinician - RN (Remote)
PA, Working at Home - Pennsylvania, United States

Highmark Health

Coding criteria Health care services Medical Documentation Payment Integrity Claims analysis Provider education Utilization management RN Managed Care +10

Senior Mid Full Time

USD 57K+

Field Reimbursement Manager, Pulmonology and Gastroenterology - Denver, CO
Remote, US, United States

Access Issue Resolution Financial assistance Patient Support Services Gastroenterology Rare diseases Appeals Patient Support Biologics Prior authorization +25

USD 122K+

Care Management Support Professional
TRIL JACKSONVILLE, United States

Non-clinical Assessment Social determinants Clinical programs Chronic Condition Management Health education Driver safety program Social services Community Health Acute care +54

USD 25K+

Associate Director, UM Nursing
Remote US, United States

Interpreting Criteria Clinical Nursing Medical Services Prior authorization Registered Nurse Clinical knowledge Utilization management Authorization RN +45

USD 115K+

Case Manager RN (Remote), Day Shift, Utilization Management
Remote, United States

Adventist HealthCare

Independent work Crisis Management Utilization management Conflict Resolution Confidentiality Nursing Case Management Multi-tasking Documentation +3

USD 71K+

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