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Utilization management Remote Jobs

167 fresh jobs found

Head of Customer Support & Maintainance
San Mateo, CA

Innovation in healthcare EMR systems Ticketing Systems Zendesk Resource Management Utilization management Healthcare Technology CRM systems Process Optimization +14

Exec Senior Full Time

USD 115K+

Medical Director - Florida
Remote US, United States

Clinical patient care Health claims Managed Care Knowledge Post-acute services Home health services Family practice Inpatient rehabilitation Hospitalist National Guidelines +73

Exec Senior Full Time

USD 223K+

Medical Director--Claims Management
Remote US, United States

Inpatient care Clinical patient care Computer-Based Review Outpatient services Home health services Grievance and appeals processes Clinical reference materials CMS policies Post-acute care +87

Exec Senior Full Time

USD 223K+

Reimbursement Business Manager, Immunology - Houston North/West
Remote - United States, United States

Payer landscape Specialty Pharmacy Network Reimbursement Management Matrix Environment Biologics Immunology Clinical Documentation Specialty Pharmacy Pharmaceuticals +11

USD 163K+

Utilization Management Coordinator - OK
Tulsa Oklahoma HQ (1400 S. Boston Avenue), United States

Health Care Service Corporation

Clinical Data Collection Registered Nurse Clinical Experience Care Coordination Utilization management Medical terminology RN Wellness Health care +8

USD 60K+

Concurrent Review Nurse (RN)
Remote in California

Central California Alliance for Health

Health care data Medi-cal Electronic Medical Records Utilization management Case Management Critical thinking Analysis Reporting Problem-solving +2

USD 80K+

Utilization Management Nurse
Renton, WA, United States

Cambia Health Solutions

DO Disease Management Clinical Care Utilization management Clinical expertise Quality improvement Care management Nursing Auditing +15

USD 83K+

Utilization Management Behavioral Health Registered Nurse
Remote US, United States

Clinical patient care Behavioral Change Interpreting Criteria Microsoft Office Word Social service agencies Clinical Nursing Health promotion LESS Registered Nurse +54

USD 71K+

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+

Sr. Manager, UM Authorization Strategy
Remote

Clinical Policy Mitigation Strategies Technology Platform Prior authorization Performance Improvement Project Planning Utilization management Root Cause Analysis Health Insurance +18

Senior Full Time

USD 118K+

Nurse Supervisor, Utilization Management Clinical Quality
Remote

Nurse Management HEDIS measures Clinical auditing Escalations RN licensure Insurance experience Ncqa standards Healthcare quality MCG +37

USD 88K+

Clinical Systems Application Architect III
Dayton WFH, United States

Aerial 275 Jiva Zeomega Medecision Medhok Care management packages Healthedge Sdoh +75

Senior Full Time

USD 110K+

Manager, Benefit Coding and Support Implementations
Dayton WFH, United States

Benefit Coding Medical policy development Healthcare payer Medical benefit plan design Payment methodologies Health Plan Operations Facets Resolution HCPCS +42

Senior Mid Full Time

USD 92K+

Care Management Support Assistant
Work at Home - Virginia, United States

Computations Microsoft Office Word Interviewing Functions Utilization management Travel Clinical support Care management Administrative +44

Entry Mid Full Time

USD 39K+

RC Appellate Clinician - Remote
United States

Tenet Healthcare

Electronic tools Medical necessity criteria ACE Denials management UB04 Patient Accounting InterQual Managed Care Contracts EOB +29

USD 92K+

Clinical Documentation Integrity Specialist
Fully Remote

Graphical analysis 3m 360 encompass cac Abstracting medical information Medical record documentation Database programs Abstracting Coding Guidelines Medical Coding Computer Proficiency +18

USD 92K+

Manager, Analytic Development
Remote, United States

Personify Health

Cost efficiency MicroStrategy Healthcare Analytics Predictive Modeling HIPAA Compliance Utilization management Data Governance Data engineering Tableau +21

Senior Full Time

USD 130K+

Field Reimbursement Specialist - Birmingham, AL
US - Alabama - Montgomery - Field/Remote, United States

Patient health information Benefits investigation Payer prior authorization Reimbursement Process Budgets Claims resolution Denials Payer Reimbursement Issues +48

USD 155K+

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

Change resiliency Clinical care review Registered Nursing Proper grammar usage Medical Necessity Review Phone Etiquette Discharge planning Clinical Care Accreditation +35

USD 61K+

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+

Sr Onsite Clinical Care Navigator--Mission Hospital Asheville
Full Time Remote - North Carolina, United States

Clinical reviews Comprehensive assessments Healthcare Coordination Medical necessity Discharge planning Clinical Care Community Resources Referrals Utilization management +7

Senior Mid Full Time

USD 75K+

CareSource Military & Veterans President
Washington DC WFH, United States

Military culture Philanthropic strategy Clinical service delivery Managed care principles Member engagement Cultural Sensitivity NCQA Operational performance Population health +36

USD 150K+

Senior Director, Clinical Applications
Dayton WFH, United States

Software release management Automation validation Clinical integrations Technical Evaluation Real-time processing Resolution System Integration Certification Project Planning +38

Senior Full Time

USD 159K+

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

Highmark Health

Coding criteria Medical Policies Medical Documentation Payment Integrity Health care services Claims analysis Provider education Utilization management Quality improvement +11

Senior Mid Full Time

USD 57K+

Revenue Cycle Representative, Reconsiderations
Remote

Healthcare collection procedures Claims research Mathematical Calculations Invoice processing Icd-9 coding Medical claims ICD-9 CPT coding Microsoft Access +17

USD 32K+

Field Reimbursement Manager, Respiratory and Dermatology - Pensacola, FL/ Mobile, AL
Remote, US, United States

Access Issue Resolution Reimbursement support Respiratory Financial assistance Patient Support Services Patient Support Programs Dermatology Appeals Prior authorization +29

Senior Mid Full Time

USD 122K+

Utilization Management Registered Nurse
Remote US, United States

Medicaid Experience Interpreting Criteria Health Plan Experience Microsoft Office Word Clinical Nursing Medical Services Rehabilitation LESS Registered Nurse +49

USD 71K+

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+

Field Reimbursement Specialist - Detroit, MI
US - Michigan - Detroit-Field/Remote, United States

Benefits investigation Payer prior authorization Patient health information Reimbursement Process Budgets Claims resolution Denials Payer Access and Reimbursement +48

USD 155K+

Utilization Management Behavioral Health Professional
Remote US, United States

Interpreting Criteria Microsoft Office Word Social service agencies Health promotion Medical Services LESS Registered Nurse Community Health Utilization Review +51

USD 65K+

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+

UM Administration Coordinator
Remote US, United States

Computations Microsoft Office Word ICD-10 codes LESS ICD Electronic Medical Records Utilization Review Prior authorization Interviewing +49

USD 40K+

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+

Pre-Authorization Registered Nurse
Remote US, United States

Medical management systems Rehab Medicaid Experience Health Plan Experience Microsoft Office Word Clinical Nursing InterQual MCG Rehabilitation +53

USD 71K+

UM Coordinator
Work From Home (HB), United States

Health Care Service Corporation

Medical claims review Ancillary services UM Medical Necessity Review Medical claims Healthcare Management Report Preparation Medical necessity Registered Nurse +20

USD 56K+

Compliance Project Manager
United States

Cohere Health Remote-first

Clinical Intelligence Monday.com Healthcare Compliance Digital Health Utilization management Clinical expertise Process Optimization Program Management PowerPoint +11

USD 85K+

Supervisor, UM Reporting
United States

Navitus Health Solutions, LLC

Program audits PBM knowledge Data Quality Assurance Prior authorization Utilization management Health Pharmacy Creativity Medicaid +10

Senior Mid Full Time

USD 61K+

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+

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+

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+

Medical Director Utilization Management Oncology: Remote
Cerritos, California, United States

The Oncology Institute of Hope and Innovation

Clinical Decision Making Evidence-based practices Utilization management Oncology Analytical Communication

Exec Senior Full Time

USD 275K+

Utilization Management Director (CCM)
Remote

Included Health

Member Experience Manual Dexterity In-person care Specialty care Urgent care Strategic vision Virtual care Primary Care Utilization management +22

Exec Senior Full Time

USD 118K+

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+

VP, Quality & Performance Outcomes
Dayton WFH, United States

URAC Population health management Healthcare Trends Critical Listening NCQA HEDIS Population health Accreditation Credentialing +31

Exec Senior Full Time

USD 150K+

Medical Director - Medicare Grievances and Appeals Corporate
Remote US, United States

General surgery Preservice appeals Health claims Grievances Medical interpretation Hospitalist Family practice Medical background Geriatrics +41

Exec Senior Full Time

USD 246K+

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+

Manager, Utilization Management Behavioral Health
Remote US, United States

Rehabilitative Counseling Interpreting Criteria Tactical Operations Microsoft Office Word Personnel management Medical Services LESS Registered Nurse Clinical Experience +45

USD 86K+

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+

Director of Revenue Cycle Applications - Information Services - System Services Telecommuter – Day – FT
System Services-Telecommuter, United States

Sharp HealthCare

Application Oversight Change Control Processes Health care administration Governance Framework Systems Analysis Revenue Cycle Management EPIC Resource Allocation Utilization management +16

Exec Mid Full Time

USD 82K+

Manager, Utilization Management Registered Nurse
Remote US, United States

Interpreting Criteria Medicaid Experience Tactical Operations Microsoft Office Word Health Plan Experience Clinical Nursing Medical Services Rehabilitation LESS +56

USD 94K+

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