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Utilization Review Remote Jobs

68 fresh jobs found

Appeals and Grievances Clinical Specialist – RN, LPN, or Dental Hygienist - 100% Remote
Remote - NY, United States

Clinical Case Development Macess Dental Hygienist Hyland Medicare Guidelines Care Management Systems TruCare Case Resolution CCMS +18

USD 71K+

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+

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+

Clinical Operations Manager/RN-Hybrid-Jersey City, NJ
US-NJ-New Jersey-Virtual, United States

Alight Solutions

Return to work process Medical disability Guiding Medical Advisory Disability Management Leading Occupational Health Absence Management Utilization Review +21

Senior Mid Full Time

USD 72K+

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+

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+

Clinical Appeals Nurse
Mississippi WFH, United States

MDCH regulations URAC State hearings OAC Proper grammar usage Clinical appeals Phone Etiquette Facets Critical Listening +22

Exec Mid Full Time

USD 55K+

Medical Management Nurse, California
TBD, CA, United States

AmTrust Financial Services, Inc.

Best practice references Clinical resource Disability evaluation Injury assessment Medical Case Management Telephonic case management Treatment Planning Mathematical Utilization Review +19

USD 76K+

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+

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+

Utilization Review Author (Weekend)
Remote, GA, United States

Milliman Evidence-based criteria Case reviews Management experience InterQual Data Abstraction Basic Computer Intelligent Automation Utilization Review +16

USD 78K+

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+

Utilization Review Clinician - Behavioral Health
Remote-IL, United States

Centene Corporation

Healthcare Collaboration Medical appropriateness Substance abuse Treatment plans Provider education Discharge planning Clinical Review Utilization Review Treatment Planning +21

USD 52K+

Utilization Review Clinician - Behavioral Health - Weekend Shift
Remote-FL, United States

Centene Corporation

Medical appropriateness Healthcare Collaboration Substance abuse Treatment plans Discharge planning Clinical Review Utilization Review Prior authorization Medical management +20

USD 52K+

Medical Director - Pediatric Pulmonology - EviCore - Remote
Florida Work at Home, United States

The Cigna Group

Evidence-based medical reviews Evidence-Based Decision Making Medical case reviews Automated processes Case Management Software Federal Laws Computer Applications Healthcare Regulations Medical necessity +23

Exec Senior Full Time

USD 203K+

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+

Utilization Review Specialist
Remote

Clearfork Academy LP

DSM-5 Criteria Clinical appeals Insurance Coordination Treatment plans Patient advocacy Medical Records Utilization Review Data Entry

USD 50K+

Utilization Review Clinician - Behavioral Health
Remote-GA, United States

Centene Corporation

Education provision Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Prior authorization +20

USD 52K+

Business Development Director (Clinical Documentation and Coding)
Remote, UT, United States

Coding Solutions Cdi Clinical documentation improvement Team selling Outsourcing Healthcare Sales Healthcare systems Clinical Documentation Utilization Review +14

Exec Senior Full Time

USD 116K+

Utilization Review Clinician - Behavioral Health
Remote-SC, United States

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management Prior authorization +19

USD 52K+

Pharmacy Coordinator II
Remote-NV, United States

Centene Corporation

Formulary process Prior authorizations Grievances Managed care experience Health Plan Provider Relations Utilization Review Prior authorization Medical management +18

USD 77K+

VP, PHCO Utilization Management Medicaid & Marketplace
Remote-MO, United States

Centene Corporation

Ncqa standards NCQA Clinical Training Financial Forecasting Provider Relations Acute care Marketplace Reconciliation Utilization Review +25

Exec Senior Full Time

USD 182K+

Remote Medical Director (PRN) - California
Remote-CA, United States

Centene Corporation

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

Exec Mid Part Time

USD 222K+

Utilization Review Clinician - Behavioral Health
Remote-AZ, United States

Centene Corporation

Clinical licensure Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management +22

USD 95K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

Autism spectrum disorder Healthcare Provider Interaction Medical appropriateness Clinical Standards Applied Behavior Analysis Treatment plans Behavioral Analysis ABA Clinical Review +25

USD 95K+

Behavioral Health Care Coordinator (Outpatient Services)
Downers Grove (3500 Lacey Road), United States

Health Care Service Corporation

PC experience Database experience Contract Interpretation Clinical Review Medical necessity PC Utilization Review Registered Nurse Database +13

USD 60K+

IP Utilization Review Clinician - Behavioral Health
Remote-LA, United States

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Substance abuse Clinical Review Discharge planning Utilization Review Medical management Prior authorization +18

USD 52K+

Personal Health Nurse - Remote
United States

Tenet Healthcare

Personal health management Healthcare industry expertise Cost Containment Utilization Review Medical management Utilization management Technical Training Email Prioritization +18

USD 64K+

UM Administration Coordinator
Work at Home - Florida, United States

Clinical Requests CGX Computations ICD-10 codes ICD Clinical Review Electronic Medical Records Eligibility verification Utilization Review +51

USD 40K+

Utilization Review Clinician - Behavioral Health
Remote-MO, United States

Centene Corporation

Healthcare Collaboration Medical appropriateness Treatment plans Provider education Substance abuse Clinical Review Discharge planning Treatment Planning Utilization Review +21

USD 52K+

Claims Adjuster
Recruiting Only - Telecommuter, United States

Social Security Claims coding Action plans Interpretive Adjudication Keyboarding PC literate Microsoft Office products Utilization Review +25

USD 47K+

Registered Nurse RN Population Health Remote
Remote Greeley CO, United States

Community nursing Chart reviews Critical care Medicare Advantage Cerner HEDIS Risk Adjustment Utilization Review Primary Care +11

USD 112K+

Medical Director - Kansas
Remote-KS, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Medical Review Accreditation Standards +38

Exec Senior Full Time

USD 221K+

Utilization Review Nurse
Remote

Medical necessity reviews Level of care reviews Evidence-Based Guidelines Clinical Guidelines Technology Platform RN licensure Clinical Practice Acute care Clinical Review +11

USD 70K+

Director Clinical Services
Renton, WA, United States

Cambia Health Solutions

Health insurance trends Health plan case management Clinical Leadership Disease Management State regulations Utilization Review Utilization management Financial Management Care management +9

Exec Senior Full Time

USD 165K+

Claims Representative | Liability
Telecommuter NJ, United States

Social Security Claims coding Liability Claims Action plans Liability Interpretive Adjudication Keyboarding PC literate +27

USD 60K+

Remote Medical Director - Texas
Remote-TX, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Clinical quality improvement Provider network development Medical management programs Government programs Health care quality Health financing Personnel management Health administration Accreditation Standards +37

Exec Senior Full Time

USD 231K+

RN-Clinical Operations Manager-Hybrid-Jersey City, NJ
US-NJ-New Jersey-Virtual, United States

Alight Solutions

Guiding Leading Medical disability Medical Advisory Disability Management Occupational Health Absence Management Sanctions Patient advocacy +20

Senior Mid Full Time

USD 96K+

Intake Coordinator
SelectHealth - Murray, United States

Intermountain Health

Internet troubleshooting Multi-monitor setup Telephone communications Outbound Calls Computer literacy Utilization Review Referrals Typing Care management +9

USD 38K+

Remote Behavioral Medical Director - western region
Remote-CA, United States

Centene Corporation

Clinical practice improvement Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Accreditation Standards +36

Exec Senior Full Time

USD 231K+

Remote Behavioral Medical Director – West Region
Remote-CA, United States

Centene Corporation

Culturally diverse care Clinical quality improvement Medical management programs Provider network development Health care quality Health financing Personnel management Health administration Medical Review +36

Exec Senior Full Time

USD 231K+

Utilization Review Author
Remote, GA, United States

Case reviews Management experience Evidence-based criteria Milliman Data Abstraction InterQual Basic Computer Intelligent Automation Workflow Orchestration +15

USD 78K+

Virtual Utilization Review Specialist - PART TIME WEEKENDS
Work at Home - Akron - OH, United States

Ensemble Health Partners

Healthcare Resource Utilization Clinical review criteria Medical necessity determination Medical Necessity Review Medical Record Review Denial Management Clinical Review Medical necessity Utilization Review +18

USD 57K+

UM Administrative Coordinator- Medicare- WAH
Remote US, United States

Computations Rehab ICD-10 codes Clinical Leadership ICD Calendar Management Electronic Medical Records Consumer Experiences Utilization Review +51

USD 40K+

Pharmacy Technician - Clinical Services (MTM)
Remote-FL, United States

Centene Corporation

Drug Utilization Review Medication therapy management Pharmacy operations Clinical services Telephonic Outreach Pharmacy Technician Triage Bilingual Communication Utilization Review +22

Entry Full Time

USD 52K+

Remote Child & Adolescent Behavioral Medical Director - Washington
Remote-WA, United States

Centene Corporation

Adverse trend evaluation Clinical quality improvement Medical Necessity Review Provider network development Medical management programs Health care quality Health financing Clinical collaboration Personnel management +36

Exec Mid Full Time

USD 231K+

VP, PHCO Utilization Management - Medicare & Duals
Remote-FL, United States

Centene Corporation

NCQA Ncqa standards Clinical Training Financial Forecasting Provider Relations Acute care Utilization Review Medical management Training Programs +21

Exec Senior Full Time

USD 182K+

Medical Director -Pediatric Cardiology
Florida Work at Home, United States

The Cigna Group

Medical case reviews Evidence-based medical reviews Evidence-Based Decision Making Case Management Software Automated processes Federal Laws Healthcare Regulations Computer Applications Utilization Review +23

Exec Senior Full Time

USD 203K+

UM Administration Coordinator (Gulf South Region)
Remote US, United States

Computations ICD-10 codes ICD Electronic Medical Records Consumer Experiences Utilization Review ICD-10 Authorization Prior authorization +45

Entry Mid Full Time

USD 40K+

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Remote Jobs with CAD > 80K in Salary Remote Jobs with GBP > 80K in Salary Remote Jobs with EUR > 80K in Salary Remote Jobs with CAD > 100K in Salary Remote Jobs with PHP > 40K in Salary Remote Jobs with PHP > 60K in Salary Remote Jobs with PHP > 80K in Salary Remote Jobs with PHP > 240K in Salary Remote Jobs with PHP > 220K in Salary Remote Jobs with PHP > 160K in Salary Remote Jobs with PHP > 260K in Salary Remote Jobs with PHP > 120K in Salary Remote Jobs with PHP > 180K in Salary Remote Jobs with PHP > 200K in Salary Remote Jobs with PHP > 140K in Salary Remote Jobs with PHP > 100K in Salary Remote Jobs with PHP > 280K in Salary Remote Jobs with PHP > 300K in Salary Remote Jobs with CAD > 120K in Salary Remote Jobs with EUR > 100K in Salary