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Utilization Review Remote Jobs

76 fresh jobs found

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+

Utilization Review Nurse, RN
Remote, United States

Personify Health

NCCN Medscape MCG guidelines Medical Policies Hcpcs coding Medical claims Utilization Review HCPCS ICD-10 +14

Entry Mid Full Time

USD 72K+

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+

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+

Market Clinical Quality Specialist II
Florida WFH, United States

Microsoft Access Accreditation Utilization Review Clinical Experience Certification Visio Quality improvement RN Technical Writing +27

USD 70K+

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 Account Manager
Remote-MO, United States

Centene Corporation

Managed care pharmacy Disease state management Drug Utilization Review Drug therapy Clinical interventions Managed healthcare Clinical data analysis Benefit design Formulary management +30

USD 105K+

Pharmacy Coordinator
Remote-IN, United States

Centene Corporation

Formulary process Prior authorizations Grievances Employee Training Pharmacy Technician Provider Relations Utilization Health Plan Utilization Review +21

USD 64K+

Group Health Operations Manager (RN/LPN)
United States - Remote

Staffing Management Peer review LPN Computer literacy Insurance Claims Utilization Review Claims management Typing RN +12

USD 75K+

Informatics Nurse - Pre-Payment Reviewer
REMOTE OPTIONS, PHOENIX

State of Arizona

Program Integrity Federal and State Statutes Report creation Medicaid programs Interdisciplinary Collaboration Medicaid regulations Cognos Policies and procedures System Implementation +59

USD 71K+

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+

Associate Medical Director, Spine Surgery
United States

Cohere Health Remote-first

Neurosurgery Orthopedic surgery Spine surgery Peer-to-peer discussions Evidence-Based Guidelines Clinical reviews Clinical Intelligence Clinical Review Medical necessity +14

Senior Mid Full Time

USD 250K+

Clinical Consultant I
Remote, United States

Appeals management Coding validation Medical payment policy Payment policy MicroStrategy CMS guidelines Payment Claims Adjudication Clinical services +43

USD 75K+

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+

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

The Cigna Group

Evidence-based reviews Evidence-Based Decision Making Evidence-based medical reviews Medical case reviews Case Management Software Federal Laws Automated processes Computer Applications Cigna +25

Exec Senior Full Time

USD 203K+

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+

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+

Clinical Admissions Therapist (Virginia)
Remote, United States

Mental Health Diagnosis Client intake Biopsychosocial assessment Individual therapy Family therapy Evidence-based treatment Electronic Medical Records Utilization Review Telehealth +4

USD 60K+

Clinical Admissions Therapist (New York)
Remote, United States

Mental Health Diagnosis Behavioral health assessment Biopsychosocial assessment Individual therapy Family therapy Evidence-based treatment Electronic Medical Records Utilization Review Telehealth +4

USD 60K+

Clinical Admissions Therapist (Massachusetts)
Remote, United States

Biopsychosocial assessment DSM V Individual therapy Electronic Medical Record Family therapy Evidence-based treatment Utilization Review Telehealth Mental Health +4

USD 60K+

Clinical Admissions Therapist (California)
Remote, United States

Biopsychosocial assessment DSM V Individual therapy Electronic Medical Record Family therapy Evidence-based treatment Utilization Review Telehealth Mental Health +4

USD 70K+

Clinical Admissions Therapist (Other State)
Remote, United States

Biopsychosocial assessments DSM V Individual therapy Electronic Medical Record Family therapy Evidence-based treatment Electronic Medical Records Utilization Review Treatment Planning +6

USD 60K+

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+

Medical Director - Plastic Surgery
Florida Work at Home, United States

The Cigna Group

Evidence-based reviews Evidence-Based Decision Making Evidence-based medical reviews Medical case reviews Case Management Software Federal Laws Automated processes Computer Applications Cigna +25

Exec Senior Full Time

USD 203K+

RN Utilization Review - Care Coordination - Remote
Albuquerque, NM, United States

Presbyterian Healthcare Services

Epic Electronic Charting Clinical Nursing Interdisciplinary Collaboration Utilization Review EPIC Resource Management Utilization management Coordination Case Management +13

USD 102K+

Utilization Review Nurse
Remote

Clinical auditing Clinical Guidelines Medical necessity Utilization Review Medical Billing Prior authorization Microsoft Suite Quality improvement Healthcare services +12

USD 80K+

Nurse Liaison - Post Acute Care - Jacksonville, FL - Sign on Bonus
Remote

Quality Assessment Patient Care Coordination Discharge planning Registered Nurse Operational processes Utilization Review Resource Management Clinical expertise Patient Education +10

USD 80K+

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

Centene Corporation

Guidelines Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Discharge planning Utilization Utilization Review +21

USD 52K+

Remote Medical Director
Remote-MO, United States

Centene Corporation

Claims review Health financing Medical management programs Provider network development Health care quality Government programs Clinical quality improvement Health administration Personnel management +40

Exec Mid Full Time

USD 231K+

Utilization Nurse Reviewer (Remote), Day Shift, Utilization Management
Support Center, United States

Adventist HealthCare

Typing 50+ WPM Clinical Chart Review Milliman Resource Utilization CMS guidelines InterQual Windows Environment Discharge planning Utilization Review +9

USD 77K+

Utilization Review Clinician - ABA
Remote-AZ, United States

Centene Corporation

ABA services Autism spectrum disorder Guidelines Medical appropriateness Behavioral Analysis Healthcare Provider Interaction Clinical Standards Applied Behavior Analysis Treatment plans +29

USD 95K+

Clinical Admissions Associate
Remote, United States

Technology resources Biopsychosocial assessments DSM V Mental health treatment Individual therapy Electronic Medical Record Family therapy Evidence-based treatment Utilization Review +9

USD 50K+

Care Experience Specialist
Remote, United States

Cloud-based communication Contact Center Technology Mental health treatment Individual therapy Family therapy Evidence-based treatment Utilization Review Gmail Care Coordination +16

USD 45K+

RC Appellate Clinician - Remote
United States

Tenet Healthcare

Medical necessity criteria UB04 Denials management Patient Accounting Managed Care Contracts InterQual EOB Healthcare industry expertise Healthcare Management +27

USD 92K+

Behavioral Health Prior Authorization Manager
REMOTE OPTIONS, PHOENIX

State of Arizona

Medicaid programs Program Planning Health care services Report development Policies and procedures Review Equal Opportunity Provider Relations Eligibility verification +51

USD 83K+

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

Centene Corporation

Education provision Outpatient Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Utilization Clinical Review Discharge planning +23

USD 52K+

Remote Marketplace Medical Director
Remote-MO, United States

Centene Corporation

Claims review Medical management programs Provider network development Government programs Health care quality Health financing Clinical quality improvement Personnel management Health administration +39

Exec Mid Full Time

USD 231K+

Medical Director, Operations, Ortho/Spine
United States

Cohere Health Remote-first

Clinical decision guidelines Medical coverage policies Physician training Remote workforce management AI in Healthcare Peer-to-peer discussions Clinical reviews Clinical Intelligence Software tools +23

Exec Senior Full Time

USD 270K+

Complex Discharge Planner
Remote-FL, United States

Centene Corporation

Prior authorizations Health management systems Health management Medicaid regulations Utilization Discharge planning Needs Assessment Utilization Review Acute care +19

USD 95K+

UM Administration Coordinator 2
Remote US, United States

Translator certification CGX Computations Bilingual English/Spanish Process Flows Articulate Bilingual (English Utilization Review Genesys +41

USD 40K+

Genetic Counselor Clinical Reviewer - EviCore - Remote
Tennessee Work at Home, United States

The Cigna Group

Pediatric genetics Perinatal genetics Adult genetics Cigna Genetic counseling Medical Review Health education Clinical Review Utilization Review +19

USD 71K+

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

Centene Corporation

Education Development Claims review Medical management programs Provider network development Government programs Health care quality Clinical quality improvement Health financing Personnel management +41

Exec Mid Part Time

USD 212K+

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

BAYADA Home Health Care

OASIS Medicare pdgm billing PDGM Home health coding CMS guidelines Home health care ICD-10 Coding Telephone Home Care +11

USD 74K+

Non- Clinical Coding and OASIS Review Manager
Pennsauken, NJ 08109 | 39.950866919 | -75.048664024

BAYADA Home Health Care

OASIS PDGM Home health coding Medicare pdgm billing CMS guidelines Home health care Home Care Telephone Utilization Review +11

USD 62K+

Clinical Coding and OASIS Review Manager
Pennsauken, NJ 08109 | 39.950866919 | -75.048664024

BAYADA Home Health Care

Coding review PDGM Home health coding OASIS Medicare pdgm billing CMS guidelines Home health care ICD-10 Coding Home Care +13

USD 74K+

UR Index Intake Coordinator - REMOTE! Mon- Fri 10am - 7pm PST
Reno, NV, US

EK Health Services Inc.

Uploading Categorizing Scanning Indexing Internet Research Utilization Review Word Processing Medical Records MS Word +8

Entry Full Time

USD 32K+

Senior Care Manager - Psychologist - Part Time Remote
United States, United States

Magellan Health Remote-first

Neuropsychological testing Psychological testing Telephone triage DSM V Computer Systems Substance abuse Psychology Tracking Crisis Intervention +18

Senior Part Time

USD 83K+

Claims Adjuster | Workers Compensation
Telecommuter CA, United States

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

USD 60K+

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