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Utilization Review Remote Jobs

73 fresh jobs found
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Claims Adjuster - Workers Compensation - Telecommute CO
Telecommuter CO, United States

Social Security Claims coding Action plans Interpretive Adjudication Keyboarding PC literate Microsoft Office products Medical management +24

USD 60K+

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

Centene Corporation

Medical appropriateness Healthcare Collaboration Treatment plans Clinical Review Utilization Guidelines Regulatory Guidelines Discharge planning Medical management +22

USD 52K+

Telephonic Nurse Case Manager
Home United States

Medical treatment coordination Communication facilitation Health services evaluation Case management planning Cost-effective care Telephonic case management Clinical evaluation Data documentation Utilization Review +3

USD 65K+

Behavioral Health Utilization Management Clinician I - MHP or SUDP
Spokane, Washington, United States; Seattle, Washington, United States

Community Health Plan of Washington

Workflow systems Clinical Guidelines Discharge planning Community Health Clinical Experience Utilization Review Patient advocacy Utilization management Care Coordination +11

USD 73K+

Manager, Behavioral Health Care Management/RN/LCSW/LPC/LCAS- Remote in VA!
Sentara Health Plans Community Care, United States

Quality Outcome Indicators Addiction recovery Claims analysis Human services Staff Development Healthcare Management NCQA LPC Health Plan +32

Senior Mid Full Time

USD 153K+

Utilization Review Specialist
Remote, United States

Admissions Mental health treatment Utilization Review Individual therapy Family therapy Gmail Evidence-based treatment Confidentiality Behavioral health +11

Exec Mid Full Time

USD 53K+

Behavioral Health Care Coordinator (Utilization Management)
Richardson Texas HQ (1001 E. Lookout Drive), United States

Health Care Service Corporation

Database Experience Contract Interpretation Clinical Review Medical necessity PC Utilization Review Registered Nurse Clinical Experience Utilization management +14

USD 60K+

Supervisor, Behavioral Health Utilization Management
Remote-AZ, United States

Centene Corporation

UM Accreditation Standards Compliance monitoring Utilization Guidelines Medical necessity Clinical Supervision Performance Evaluation Medical management +31

USD 73K+

Medical Review Nurse
REMOTE OPTIONS, PHOENIX

State of Arizona

Prospective Review Retrospective review Concurrent review Health Care Delivery Claims review Health care services Policy compliance Medical Documentation Peer review +68

USD 71K+

Clinical Appeals Coordinator
Remote-AR, United States

Centene Corporation

Appeals coordination Ncqa compliance Ncqa standards Clinical Nursing Clinical Information Utilization NCQA Medical necessity Medical management +17

USD 66K+

UM Administration Coordinator
Remote US, United States

Computations ICD-10 codes Microsoft Office Word ICD HireVue LESS Prior authorization Electronic Medical Records Utilization Review +51

USD 40K+

Associate Director of Utilization Review
Remote

Compass Health Center

Healthcare administration Utilization Review Patient advocacy Case Management Behavioral health Mental Health Time Management Microsoft Office Documentation +4

USD 75K+

Clinical Consultant I
Remote, United States

Coding validation Appeals management Medical payment policy Payment policy Payment CMS guidelines MicroStrategy Adjudication Claims Adjudication +45

USD 75K+

Remote Medical Director - California
Remote-CA, United States

Centene Corporation

Adverse trend evaluation Medical Necessity Review Health financing Medical management programs Provider network development Health care quality Clinical quality improvement Health administration Government programs +44

Exec Senior Full Time

USD 231K+

Utilization Review Specialist - Behavioral Health (Remote)
United States

Advanced Recovery Systems

Insurance Coordination Medical Documentation Records Management Utilization Review Data Entry Behavioral health Time Management Communication

USD 50K+

Utilization Review Intake Specialist
Remote, United States

Personify Health

Wellbeing Medical claims Hcpcs coding Utilization Review HCPCS ICD-10 Utilization management CPT Claims processing +15

Entry Mid Full Time

USD 36K+

Medical Director - EviCore - Remote (Family Medicine, Internal Medicine or Emergency Medicine)
Florida Work at Home, United States

The Cigna Group

Evidence-based medical reviews Medical case reviews Evidence-Based Decision Making Cigna Automated processes Federal Laws Clinical Judgment Computer Applications Case Management Software +24

Entry Mid Full Time

USD 203K+

Clinical Appeal Nurse - Remote $10K Sign on Bonus
United States

Tenet Healthcare

Patient accounting knowledge Electronic tools Medical necessity criteria Denials management ACE InterQual UB04 Patient Accounting Managed Care Contracts +32

USD 92K+

Remote Clinical Care Manager
Joliet, IL, United States

MS Access Clinical Judgment State regulations Community Health Utilization Review Predictive Analytics MS Word MS Excel Managed Care +11

Senior Mid Full Time

USD 75K+

Nurse Liaison - Post Acute Care (Hybrid) Utica, NY Sign-on bonus
Remote

Quality Assessment Patient Care Coordination Home health care Discharge planning Operational processes Registered Nurse Utilization Review Resource Management Utilization management +16

USD 80K+

Clinical Care Analyst
New York City, New York, United States

Healthmap Solutions

Medical Records Review Social Determinants of Health Clinical assessment Utilization Review Care management Multitasking Critical thinking Microsoft Office Presentation +3

USD 105K+

Non-Clinical Coding and OASIS Review Manager
Austin, TX 78702 | 30.265823127 | -97.718701312

BAYADA Home Health Care

OASIS Home health coding PDGM Medicare pdgm billing Coding review CMS guidelines Home health care Telephone Home Care +12

USD 62K+

Non-Clinical Coding and OASIS Review Manager
Orlando, FL 32802 | 28.544658 | -81.377585

BAYADA Home Health Care

OASIS Home health coding PDGM Medicare pdgm billing Coding review CMS guidelines Home health care Telephone Home Care +12

USD 62K+

Clinical Coding and OASIS Review Manager
Austin, TX 78701 | 30.266876622 | -97.7441039

BAYADA Home Health Care

OASIS Coding review PDGM Home health coding Medicare pdgm billing CMS guidelines Home health care ICD-10 Coding Telephone +12

USD 74K+

Clinical Coding and OASIS Review Manager
Orlando, FL 32801 | 28.543443342 | -81.375916213

BAYADA Home Health Care

OASIS Coding review PDGM Home health coding Medicare pdgm billing CMS guidelines Home health care ICD-10 Coding Telephone +12

USD 74K+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Orthopedic spine surgery Spine surgery Neurosurgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Review Clinical Intelligence Medical necessity +13

Senior Mid Full Time

USD 250K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Review Clinical Intelligence Medical necessity Clinical Acumen Operational Improvements +11

Senior Mid Full Time

USD 200K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Healthcare Programs Retrospective review Concurrent review Accreditation Compliance Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity +24

USD 66K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Healthcare Programs Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity Acute care Prior authorization +23

USD 70K+

Client Policy Manager I
Remote, United States

Medical payment policy Payment policy Healthcare Claims Clinical coding Reimbursement methodologies Medical policy ICD CMS guidelines Payment +32

USD 75K+

Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
Tennessee Work at Home, United States

The Cigna Group

Case conferences Medical licenses Board certifications Peer-to-peer discussions Cigna Ncqa standards Federal Laws Medical Review Clinical Review +21

Exec Senior Full Time

USD 203K+

Utilization Review/Appeals Clinician - ABA
Remote-FL, United States

Centene Corporation

ABA services Autism spectrum disorder Medical appropriateness Clinical Standards Applied Behavioral Analysis Behavioral Analysis Healthcare Provider Interaction Applied Behavior Analysis Treatment plans +28

USD 52K+

Personal Health Nurse - Remote
United States

Tenet Healthcare

Clinical analysis Personal health management Email proficiency Care Plan Development Cost Containment Medical management Healthcare industry expertise Utilization Review Utilization management +21

USD 64K+

Public Health Nursing Consultant - Quality Assurance
REMOTE OPTIONS, PHOENIX, TUCSON

State of Arizona

Federal and State Statutes Medicaid regulations Healthcare quality Medicaid programs Policies and procedures Arizona Administrative Code Quality of care Review Performance measures +52

USD 72K+

Public Health Nursing Consultant - Case Management
REMOTE OPTIONS, PHOENIX

State of Arizona

Federal and State Statutes Medicaid regulations Healthcare quality Medicaid programs Data Tracking Policies and procedures Arizona Administrative Code Quality of care Review +53

USD 72K+

assistant vice president
Recruiting Only - Telecommuter, United States

Staffing Management Medical Support Program strategy Performance development Policy compliance Performance competencies Client satisfaction PC literate Keyboarding +29

Exec Senior Full Time

USD 120K+

Help Desk Representative - Healthcare - Remote US
Any city, WI, US, 99999

Gainwell Technologies

Healthcare guidelines Written and verbal communication Help Desk Adjudication Insurance policies Processes Utilization Review Operating Systems Government +21

USD 29K+

Medical Director
Remote-IL, United States

Centene Corporation

Health financing Health care quality Medical management programs Substance Use Disorders Provider network development Clinical quality improvement Government programs Clinical Quality Substance use +45

Exec Senior Full Time

USD 221K+

Senior Professional Nurse
Topeka, KS, US, 66619-1448

Gainwell Technologies

Billing audits DRG coding Medical Review Provider education DRG Accuracy ICD-9 Utilization Review HCPCS +33

Senior Full Time

USD 64K+

Senior Professional Nurse- Remote
Topeka, KS, US, 66619-1448

Gainwell Technologies

DRG coding Billing audits Medical Review Provider education DRG Accuracy ICD-9 HCPCS Utilization Review +33

Senior Full Time

USD 64K+

Utilization Review Nurse
Remote

Level of Care Reviews Medical necessity reviews RN licensure Evidence-Based Guidelines Treatment Clinical Guidelines Clinical Judgment Clinical Review Clinical Practice +14

USD 70K+

Clinical Admissions Therapist (New Hampshire)
New Hampshire, United States

Mental Health Diagnosis Biopsychosocial assessments Technology resources Client intake Biopsychosocial assessment Electronic Medical Record Admissions Mental health treatment Electronic Medical Records +14

USD 60K+

Clinical Admissions Therapist (Nebraska)
Remote, United States

Mental Health Diagnosis Biopsychosocial assessments Technology resources Behavioral health assessment Biopsychosocial assessment Electronic Medical Record Admissions Mental health treatment Electronic Medical Records +14

USD 60K+

Clinical Admissions Therapist (Georgia)
Remote, United States

Mental Health Diagnosis Biopsychosocial assessments Technology resources Biopsychosocial assessment Electronic Medical Record Admissions Mental health treatment Electronic Medical Records Utilization Review +13

USD 60K+

Clinical Admissions Therapist (Colorado)
Remote, United States

Biopsychosocial assessments Technology resources DSM V Electronic Medical Record Admissions Mental health treatment Electronic Medical Records Utilization Review Individual therapy +13

USD 60K+

Clinical Admissions Therapist (Kentucky)
Remote, United States

Biopsychosocial assessments Technology resources DSM V Electronic Medical Record Admissions Mental health treatment Electronic Medical Records Utilization Review Individual therapy +13

USD 60K+

Clinical Admissions Therapist (Maryland)
Remote, United States

Intensive Outpatient Program Biopsychosocial assessments Technology resources Biopsychosocial assessment DSM V Electronic Medical Record Admissions Mental health treatment Utilization Review +13

USD 60K+

Clinical Admissions Therapist (Michigan)
Remote, United States

Biopsychosocial assessments Technology resources Biopsychosocial assessment DSM V Electronic Medical Record Admissions Mental health treatment Utilization Review Individual therapy +12

USD 60K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity Clinical Acumen Utilization Review +11

Senior Mid Full Time

USD 200K+

Prior Authorization LVN Nurse - Remote
United States

Tenet Healthcare

EZ-CAP Medical management documentation system LVN Healthcare industry expertise ICD-9 CPT coding Acute care Utilization Review Medical management +24

USD 81K+

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