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Utilization Review Remote Jobs

60 fresh jobs found

Utilization Specialty OT Therapist Pediatric
Remote-TX, United States

Centene Corporation

Outpatient Therapy Services Clinical recommendations Evidenced Based Practice Pediatric care Authorization requests Operations support Documentation standards Network management +17

USD 118K+

Remote Behavioral Medical Director
Remote-IL, United States

Centene Corporation

Clinical practice improvement Health financing Provider network development Medical management programs Health care quality Health administration Personnel management Medical Review Clinical Quality +31

Exec Senior Full Time

USD 231K+

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

The Cigna Group

Case conferences Medical care management Board certification Educational training Ncqa standards Peer-to-peer discussions Medical Review Quality of care Federal Laws +21

Exec Senior Full Time

USD 203K+

Behavioral Health Inpatient Care Manager - Initial Clinical Examiner Team- Evernorth Health Services- Remote
California Work at Home, United States

The Cigna Group

Technology navigation Technology systems Treatment plans Mental Health Counseling Medical necessity Behavioral healthcare Utilization Review Discharge planning Health Services +25

USD 65K+

RN Clinical Auditor
Work at Home - Ohio - Other, United States

Ensemble Health Partners

Clinical auditing CMS rules Nursing practices Healthcare Standards DRG EMR systems Healthcare Regulations Electronic Medical Records Medical necessity +23

USD 56K+

Claims Adjuster III - Agriculture
Fresno, CA, United States

AmTrust Financial Services, Inc.

Legal Document Interpretation Claims Administration Mathematical Utilization Review Workers Compensation Time Management Negotiation Data analysis Problem-solving +1

Senior Mid Full Time

USD 83K+

Part-Time Weekend Medical Director
Remote-FL, United States

Centene Corporation

Health financing Government programs Medical management programs Provider network development Health administration Health care quality Personnel management Medical Review Clinical Quality +32

Exec Senior Part Time Full Time

USD 231K+

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

Gainwell Technologies

Help Desk Written and verbal communication Processes Utilization Review Operating Systems Claims Government Medical Feedback +17

USD 29K+

Utilization Management Behavioral Health Professional
HGB SCA Remote KY, United States

Autism spectrum disorder Interpreting Criteria Tricare Applied Behavioral Analysis Medical Services CPT codes Prevention Productivity Process Management +48

USD 65K+

Clinical Account Manager
Remote-MO, United States

Centene Corporation

Clinical interventions Disease state management Benefit design Drug therapy Formulary management Drug Utilization Review Clinical pharmacy Pharmacy operations Clinical programs +18

USD 105K+

Utilization Management Nurse Consultant
Work At Home-Illinois, United States

Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication Medical necessity +25

USD 64K+

Prior Authorization Utilization Review - PASRR (Remote Nurse)
Any city, TX, US, 99999

Gainwell Technologies

Functions Utilization Review Claims Clinical expertise RN Case Management Nursing Medicaid Medical +17

USD 65K+

Clinical Advisor
Work From Home (HB), United States

Health Care Service Corporation

Healthcare Management Healthcare Consulting Clinical Care Client Support Utilization Review Medical management Utilization management Consultative Quality Management +25

Senior Full Time

USD 66K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Retrospective review Concurrent review Accreditation Compliance Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes +20

USD 70K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Concurrent review Healthcare programs Accreditation Quality Metrics Clinical Intelligence Patient outcomes Clinical Review Medical necessity Utilization Review +18

USD 66K+

Utilization Management Clinical Consultant - Remote Kentucky
Work At Home-Kentucky, United States

Healthcare services coordination Triage support Crisis support Clinical Practice Guidelines Navigating multiple systems Keyboarding Benefit management Benefit utilization Evidence-Based Care +24

USD 52K+

Clinical Case Manager Behavioral Health
Work At Home-Texas, United States

Community resource identification Provider coordination Bilingual Spanish and English Clinical Tools RN license Data Review Care Planning Telephonic Communication Crisis Intervention +32

USD 60K+

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

Community Health Plan of Washington

Workflow systems Clinical Guidelines Patient advocacy Utilization Review Discharge planning Care Coordination Utilization management Care management Clinical Experience +9

USD 73K+

Deputy Assistant Director
REMOTE OPTIONS, PHOENIX

State of Arizona

Medicaid programs Quality outcomes Programmatic decisions Procurement initiatives Policy decisions Clinical Initiatives Managed care operations Administrative hearings Quality of care +57

Exec Senior Full Time

USD 110K+

Utilization Management Nurse Consultant
Work At Home-Florida, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +21

USD 52K+

RN - Utilization Review
WI-REMOTE, United States

ANA Code of Ethics Nursing Standards Payor Decision Electronic Medical Record Authorization Utilization Review Clinical Information RN Nursing +2

USD 67K+

Remote Medical Director - Michigan
Remote-MI, United States

Centene Corporation

Clinical practice improvement Health financing Provider network development Medical management programs Health care quality Health administration Personnel management Medical Review Clinical Quality +31

Exec Senior Full Time

USD 221K+

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

Centene Corporation

Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Provider education Clinical Review Utilization Review Discharge planning Treatment Planning +18

USD 52K+

Utilization Management Nurse Consultant
Work At Home-New York, United States

Healthcare services coordination Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria Computer Systems RN licensure Telephonic Communication +25

USD 64K+

Clinical Case Manager Behavioral Health DSNP- Spanish Speaking
Work At Home - Utah, United States

Substance abuse knowledge Clinical Case Management Substance abuse disorders Provider coordination Concurrent review Bilingual Spanish and English Spanish Speaking Community Resource Coordination Substance abuse +32

USD 54K+

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

Centene Corporation

Education provision Medical appropriateness Healthcare Collaboration Treatment plans Substance abuse Clinical Review Utilization Review Discharge planning Health Services +17

USD 52K+

Utilization Review Nurse Consultant - Oncology and Transplant
Work At Home-Arizona, United States

Evidence-based criteria Transplant Clinical call center Concurrent review Clinical Practice Guidelines Telephone Communication Navigating multiple systems Clinical Criteria Disease Management +21

Entry Mid Full Time

USD 52K+

Utilization Management Nurse Consultant
Work At Home-North Carolina, United States

Multi-systems navigation Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Clinical Criteria RN licensure Electronic Medical Records +24

USD 52K+

RN Nurse Case Management Lead Analyst - Work from Home, Anywhere, USA
Pennsylvania Work at Home, United States

The Cigna Group

Myndshft Nimble learning Clinical criteria review Cover My Meds Nurse Case Management Analytics Reporting Database navigation Decision quality Medical necessity +26

Senior Full Time

USD 76K+

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

Ensemble Health Partners

Healthcare Resource Management Clinical review criteria Medical necessity determination Medical Necessity Review Denial Management Clinical Review Medical necessity Color Utilization Review +15

USD 70K+

Utilization Management Clinician Behavioral Health
Work At Home-Pennsylvania, United States

Navigating systems Clinical Practice Guidelines Navigating multiple systems Keyboarding Coverage determination Benefit management Benefit utilization Mental health services Evidence-Based Care +23

USD 60K+

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

The Cigna Group

Medical case reviews Evidence-Based Decision Making Evidence-based medical reviews Case Management Software Automated processes Computer Applications Federal Laws Healthcare Regulations Medical necessity +22

Exec Senior Full Time

USD 203K+

Medical Director- Radiation Oncology - EviCore
Florida Work at Home, United States

The Cigna Group

Medical case reviews Medical Case Management Evidence-based reviews Case Management Software Evidence-Based Decision Making Evidence-based medical reviews Automated processes Computer Applications Federal Laws +30

Exec Senior Full Time

USD 203K+

Utilization Review Specialist
Remote

Clearfork Academy LP

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

USD 50K+

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

The Cigna Group

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

Exec Senior Full Time

USD 203K+

Medical Director - Clinical Biochemical Genetics or Clinical Genetics - EviCore
Florida Work at Home, United States

The Cigna Group

Clinical genetics Clinical biochemical genetics Medical case reviews Evidence-Based Decision Making Case Management Software Evidence-based medical reviews Automated processes Evidence-based medicine Computer Applications +25

Exec Senior Full Time

USD 203K+

Medical Director - New Hampshire
Remote-NH, United States

Centene Corporation

Health financing Provider network development Medical management programs Health administration Health care quality Personnel management Medical Review Medical Services Accreditation Standards +27

Exec Senior Full Time

USD 206K+

Clinical Case Manager Behavioral Health DSNP
Work At Home-Pennsylvania, United States

Provider coordination Substance abuse disorders Licensed Clinical Professional Counselor Licensed Mental Health Counselor Technological Clinical Tools Substance abuse Data Review Licensed Marriage and Family Therapist +26

USD 60K+

Utilization Management Nurse Consultant
Work At Home-Pennsylvania, United States

Keyboarding Coverage determination Healthcare Coordination Benefit utilization Benefit management Computer Systems Clinical Criteria Telephonic Communication RN licensure +25

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Ohio, United States

Medical Necessity Review Coverage determination Benefit management Benefit utilization Clinical Criteria Telephonic Communication Medical necessity Acute care Clinical Judgment +30

USD 52K+

Utilization Management Nurse Consultant
Work At Home-Texas, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 58K+

Utilization Management Nurse Consultant
Work At Home-Arizona, United States

Medical Necessity Review Coverage determination Benefit utilization Benefit management Clinical Criteria Telephonic Communication Medical necessity Acute care Discharge planning +30

USD 52K+

Medical Director - Washington
Remote-WA, United States

Centene Corporation

Provider network development Medical management programs Health care quality Claims review Medical Review Cost Containment Medical necessity Medical management Utilization Review +8

Exec Mid Full Time

USD 206K+

Dental Consultant (Dentist) - Cigna Healthcare - Remote
Kansas Work at Home, United States

The Cigna Group

Dental claims Predetermination treatment plans Oral health care Treatment plans Dental Terminology IT systems Utilization Review Clinical Documentation Client service +17

Senior Full Time

USD 79K+

Medical Director - EviCore
Florida Work at Home, United States

The Cigna Group

Evidence-Based Decision Making Evidence-based medical reviews Case Management Software Automated processes Computer Applications Federal Laws Healthcare Regulations Medical necessity Utilization Review +21

Exec Senior Full Time

USD 196K+

Dental Consultant (Dentist) - Cigna Healthcare - Remote
California Work at Home, United States

The Cigna Group

Dental claims Oral health care Treatment plans IT systems Utilization Review Clinical Documentation Client service Microsoft PowerPoint Behavioral health +15

Senior Full Time

USD 79K+

Associate Medical Director, Orthopedic Surgery
United States

Cohere Health Remote-first

Orthopedic surgery Evidence-Based Guidelines Peer-to-peer discussions Software tools Clinical Review Medical necessity Clinical Intelligence Clinical Acumen Utilization Review +12

Senior Mid Full Time

USD 200K+

Associate Medical Director, Utilization Management
United States

Cohere Health Remote-first

Medical necessity documentation Managed Care Knowledge Evidence-Based Guidelines Peer-to-peer discussions Clinical Decision Making Software tools Clinical Review Medical necessity Clinical Intelligence +12

Senior Mid Full Time

USD 200K+

UR Index Intake Coordinator - REMOTE! Mon- Fri 10am - 7pm PST
United States

EK Health Services Inc.

Uploading Categorizing Scanning Indexing Internet Research Word Processing Medical Records Utilization Review Medical terminology +7

Entry Full Time

USD 32K+

Public Health Nursing Consultant
REMOTE OPTIONS, PHOENIX

State of Arizona

Health care services Operational reviews Federal and State Statutes Review Medicaid regulations Quality of care Healthcare quality Hybrid Policies and procedures +47

USD 72K+

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