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Utilization management Remote Jobs

78 fresh jobs found

Utilization Management Nurse Consultant
Work At Home-Nevada

Clinical Judgement Long Term Care Benefit management Benefit utilization Home Health Clinical Criteria Acute care Prior authorization Call Center Experience +15

USD 58K+

Behavioral Health - Utilization Management Clinical Consultant - KY
Work At Home-Kentucky

Clinical Practice Guidelines Benefit management Benefit utilization Navigating multiple systems Clinical Criteria Utilization Review Evidence-Based Care Keyboarding Clinical Practice +22

USD 52K+

Clinical Operations Solution Architect (Remote within MST/CST/EST Regions)
United States - Remote

Public sector healthcare Fulfillment processes RFP analysis Implementations Healthcare Solutions Healthcare policy Clinical assessments Clinical assessment Process Flows +32

Senior Mid Full Time

USD 120K+

Regional Vice President (Clark County, NV)
Remote-Henderson, Nevada, United States

Alignment Health

Market Planning P&L Management Health Economics Market strategy Supervisory Utilization management Quality improvement Operational Excellence Contract Negotiation +15

Exec Senior Full Time

USD 200K+

Pharmacy Technician, Specialty
Remote

Pharmacy Claims Adjudication Benefit Design PBM Pharmacy Technician Administrative Tasks Healthcare experience Utilization management Multi-tasking Empathy +4

USD 44K+

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

Highmark Health

Health coaching Clinical Experience Utilization management Care management Healthcare services Managed Care Case Management HIPAA Clinical +12

USD 50K+

UM Nurse Consultant
Work At Home-Texas

Benefit utilization Benefit management Coverage determination RN licensure Navigating multiple systems Clinical Criteria Keyboarding Discharge planning Registered Nurse +16

USD 58K+

Clinical Research Scientist
Remote US

Recommender system Spark r Spark/Scala Clinical Informatics Judgement Recommender Systems Analyzing Network Analysis Clinical Strategy +63

USD 69K+

Appeals Nurse Consultant (Remote)
Work At Home-Pennsylvania

Pre authorization Appeals Pre-certification RN licensure Medical necessity Computer Systems Utilization management RN Clinical Experience +10

USD 60K+

RN Reviewer
United States

MCG Care Guidelines Healthcare programs Clinical Intelligence Accreditation Prior authorization Patient outcomes Clinical Review Medical necessity Agility +13

USD 70K+

Inpatient Review Nurse (RN/LVN) Must have California Licensure
Remote-US, California, United States

Alignment Health

Inpatient review Milliman care guidelines Concurrent review Managed Care Plans LVN California licensure Medicare managed care plans Medicare Managed Care Utilization management +17

USD 74K+

Employee Health Plan Pharmacist
UVMMC - Out of State Remote Worker

The University of Vermont Medical Center

Cost-Savings Analysis Medication Use Optimization Formulary management Utilization management Pharmacy

Entry Mid Full Time

USD 110K+

Utilization Management Clinical Supervisor
Work From Home - AZ

Virtual collaboration Quality audits Clinical Review Clinical Supervision Microsoft Applications HCPCS CPT Utilization management Performance monitoring +25

USD 55K+

Clinical Support Coordinator - Overnights
00000, US

Community Resource Research Crisis Triage Care transitions Behavioral health services Employee Assistance Programs Behavioral health care Telephonic Communication Community Resources Client Support +11

Entry Mid Full Time

USD 38K+

Utilization Management Nurse – Weekend Schedule (Central Region)
Remote US

Health Plan Experience Interpreting Criteria Clinical Nursing Milliman Medical Services InterQual MCG Acute care Discharge planning +41

USD 69K+

Case Manager - LHB
Work From Home (HB)

Health Care Service Corporation

RN license Condition Management MS Outlook Clinical Care Utilization management RN MS Word MS Excel Nursing +17

USD 55K+

Behavioral Health Case Management Coordinator (RICHARDSON – TELECOMMUTER/REMOTE)
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

Bilingual English/Polish Health Case Management Familiarity with Ancillary Services Database experience Bilingual English/Spanish Discharge planning Clinical Practice Registered Nurse Clinical Care +19

USD 58K+

Associate, Medical Policy Development
Remote

Medical policy development Clinical Policy Quality Auditing Claims auditing Medical Coding Medical Writing Technology Platform Utilization management Policy Development +15

USD 98K+

Pharmacy Customer Service Representative
Remote

Call tracking Pharmacy benefit management PBM Pharmacy Technician Healthcare experience Utilization management Claims processing Benefits Healthcare +4

USD 42K+

Primary Nurse Case Admin I (NICU Speciality) - Health Advocacy Solutions
Richardson Texas HQ (1001 E. Lookout Drive)

Health Care Service Corporation

NICU specialty RN license Coordination of care Wellness education Database experience Medical Management Policies Lotus Notes Milliman guidelines Condition Management +27

USD 58K+

Utilization Management Clinician Behavioral Health
Work At Home-Pennsylvania

Clinical Practice Guidelines Healthcare services coordination Benefit utilization Benefit management Coverage determination Clinical Criteria Utilization Review Evidence-Based Care Clinical Practice +14

USD 60K+

Medicare Grievances and Appeals Corporate Medical Director
Remote US

Preservice appeals General surgery Health claims Medical interpretation Family practice Hospitalist Medical background Emergency Medicine Geriatrics +35

Exec Senior Full Time

USD 241K+

Utilization Management Nurse, Part-Time (Gulf South Region)
Work at Home - Louisiana

Clinical Nursing Interpreting Criteria Health Plan Experience Milliman Medical Services MCG Acute care Prior authorization Discharge planning +43

USD 69K+

Quality Manager - RN (Remote, preferred within Illinois)
Illinois, United States - Remote

Action plans Implementations Continuous Quality Improvement Clinical Solutions Utilization Review Clinical Practice Public Sector Performance Improvement RN +26

Senior Mid Full Time

USD 90K+

UM Nurse Consultant (Remote)
Work At Home-New York

Benefit management Benefit utilization Coverage determination Clinical Criteria Navigating multiple systems RN licensure Keyboarding Registered Nurse Clinical Judgment +15

USD 64K+

Senior Process Improvement Professional
Remote US

NCQA Lucid Data Presentation Data evaluation Functions Business Process Operational processes Lean Six Sigma Dental +47

Senior Mid Full Time

USD 76K+

Medical Director--Claims Management
Remote US

Medicare Guidelines Inpatient Care Grievance and appeals processes Coding practices Outpatient services MCG Inpatient rehabilitation National Guidelines Post-acute care +73

Exec Senior Full Time

USD 199K+

UM Nurse Consultant (Remote)
Work At Home-Iowa

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

USD 52K+

Utilization Management Nurse Consultant
High Point-4050 Piedmont Parkway

Benefit utilization Benefit management Coverage determination RN licensure Clinical Criteria Telephonic Communication Medical necessity Telemetry Utilization Review +27

USD 52K+

Director, Utilization Management Authorization Strategy
Remote

Growth-stage company experience Financial Evaluation Healthcare Strategy Program Design Technology Platform Cross-functional Leadership Management consulting Utilization management Team Development +17

Exec Senior Full Time

USD 156K+

Utilization Management Nurse Consultant
Work At Home-New York

Benefit management Benefit utilization Coverage determination RN licensure Clinical Criteria Acute care Telephonic Communication Keyboarding Medical necessity +21

USD 64K+

Medical Director - Florida
Remote US

Coding practices Health claims review Outpatient services Grievance and appeals processes MCG National Guidelines Inpatient rehabilitation Clinical Standards Post-acute care +74

Exec Senior Full Time

USD 199K+

RN Utilization Management, Behavioral Health
Remote US

Medical necessity reviews MCG Medical Services InterQual EMR systems Dental Vision Clinical Documentation Bilingual English/Spanish +43

USD 69K+

Part Time Dental Consultant - Florida
Work From Home - FL

Dental claims Medical necessity determination Provider Appeals Chip Fraud waste abuse Adjudication Provider Relations Network management Clinical Review +22

USD 200K+

Senior Manager, Pharmacist, Formulary & Utilization Management Operations
Remote

Policy Review Formulary management Prior authorization Clinical Review Workforce management Technology Platform Utilization management Clinical operations Pharmacy +12

Senior Full Time

USD 158K+

Senior Manager, Clinical Policy Development
Remote

Health insurance policy Affordability goals Clinical Policy Technology Platform Utilization management Quality Standards Clinical operations Quality improvement Policy Development +14

Senior Full Time

USD 131K+

Utilization Management Technician - Remote
United States

Tenet Healthcare

General computers Healthcare industry expertise Utilization management Medical terminology Managed Care Data Entry Word Healthcare Excel +1

Entry Mid Full Time

USD 43K+

Director of Care Management - Aetna Better Health Louisiana (Remote)
Work At Home-Louisiana

Cross-Functional Integration Health Risk Screenings Comprehensive Assessments Care Plan Development Member engagement Policies and procedures Business Process Improvement Clinical Practice Care Coordination +21

Exec Senior Full Time

USD 99K+

Utilization Management Coordinator - LHB
Work From Home (HB)

Health Care Service Corporation

Healthcare Management Registered Nurse Utilization management Managed Care Nursing Prioritization Case Management Written communication Insurance +5

Entry Mid Full Time

USD 55K+

Utilization Management Nurse Reviewer
United States - Remote

Medical Management Platforms Microsoft Tools Evidence-Based Guidelines Peer review Utilization Review RN Utilization management Clinical knowledge Microsoft PowerPoint +9

USD 45K+

UM Administration Coordinator
Remote US

ICD-10 codes Home Health Prior authorization Dental Vision Electronic Medical Records ICD Utilization Review Healthcare services +38

Entry Mid Full Time

USD 37K+

Primary Nurse Case Admin I- Boeing
Chicago Illinois HQ (300 E. Randolph Street)

Health Care Service Corporation

Wellness education Medical Management Policies Lotus Notes Milliman guidelines Condition Management Database experience Disease Management PC Proficiency Discharge planning +24

USD 58K+

Part Time National Dental Specialist, Florida
Work From Home - FL

Provider Appeals Dental claims Fraud waste abuse Chip Adjudication Provider Relations Clinical Review Medical necessity Medicare Advantage +20

USD 200K+

Dental Director - Florida
Work From Home - FL

Dental program management Provider Relations Network management Clinical Review Credentialing Fraud Investigation Microsoft Suite Utilization management Leadership Development +14

Exec Senior Full Time

USD 90K+

Remote Inpatient Review RN / LVN Nurse, Must have California Licensure (Long-Term Temp w/ Med Benefits)
Remote-US, California, United States

Alignment Health

Inpatient review Concurrent review Milliman care guidelines California licensure Managed Care Plans LVN Medicare managed care plans Medicare Managed Care RN +18

USD 74K+

Utilization Management Nurse Consultant
Work At Home-Florida

Benefit management Benefit utilization Coverage determination Navigating multiple systems Clinical Criteria RN licensure Electronic Medical Records Keyboarding Utilization Review +20

USD 52K+

Clinical Strategy Advancement Advisor
Remote US

Dental Vision Home Health Clinical Strategy Executive communications Acute care Strategic direction Executive Communication Network management +56

Senior Full Time

USD 112K+

Senior Director, Architecture
Remote

Clinical Intelligence X12 Patient outcomes HITRUST Prior authorization FHIR HL7 Healthcare Technology Utilization management +27

Senior Full Time

USD 225K+

Senior Strategy Advancement Professional - Medicaid Capture Management
Remote US

Program Integrity Long-term Services and Supports Member Services Grievance and appeals Medicaid programs Social Determinants of Health Strategy Consulting Health Information Technology Enrollment +63

Senior Full Time

USD 84K+

Utilization Management Nurse Consultant
Work At Home-North Dakota

Outpatient therapy Google Chrome Internet Explorer Multidisciplinary teamwork Clinical Decision Making Benefit management Benefit utilization Coverage determination Navigating multiple systems +24

USD 58K+

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