Remote Medical Necessity Jobs
Remote from:
Software Development 17838B2B Sales & Account Management 10968CRM & Direct Marketing 10917Product 9303Back-End Development 9223Management and Leadership 8423Data and Analytics 8147finance 8094IT & Engineering 6553Enterprise Sales 6500Project & Program Management 5958Customer Support & Service 5958Sustainability & CSR 5474Sales Leadership & Strategy 5011DevOps & Infrastructure 4737Growth & Performance 3338Front-End Development 2857
75 jobs
Sort by:
Grievance & Appeals Specialist
Grievance & Appeals Specialist
Today
The CGC Group
- Remote: United States
- Fixed term
Utilization ManagementGrievance ArbitrationMedical NecessityCompliance ManagementMedical AbbreviationsMedicare
Career Opportunities: Utilization Review Nurse (Remote- Maine RN Only) (30353)
Career Opportunities: Utilization Review Nurse (Remote- Maine RN Only) (30353)
1 day ago
Gainwell Technologies LLC
- Remote: Maine (USA)
- Full time
Utilization ManagementInterQual CriteriaMedical NecessityClinical DocumentationHospital ExperiencePrior Authorization
RN Appeals Analyst
RN Appeals Analyst
1 day ago
BlueCross BlueShield of South Carolina
- Remote: Tennessee (USA)
- Full time
Clinical Data AnalysisUtilization ManagementManaged CareMedical NecessityHome Health CareOnline Communication
Orthopedic Surgery - Spine Surgeon - NV
Orthopedic Surgery - Spine Surgeon - NV
1 day ago
Dane Street, LLC
- Remote: Nevada (USA)
- Fixed term
Medical NecessityClinical ConsultingCredential ManagerInsurance ReviewsInternal Documentation
New Mexico-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
New Mexico-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
1 day ago
Dane Street, LLC
- Remote: New Mexico (USA)
- Freelance
Insurance Follow-UpMedical NecessityClinical ConsultingPsychiatryMedical OncologyGastroenterology
Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN)
Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN)
1 day ago
Dane Street, LLC
- Remote: North Carolina (USA)
- Freelance
Insurance ReviewsMedical NecessityClinical ConsultingPeer ReviewEvidence-Based PracticeOphthalmology
Physician Reviewer, Neurological Surgery - NV
Physician Reviewer, Neurological Surgery - NV
1 day ago
Dane Street, LLC
- Remote: Nevada (USA)
- Fixed term
Utilization ManagementAdvisory CircularMedical NecessityClinical ConsultingMedical Licensing (Health Law)Internal Documentation
Utilization Review Nurse - Remote
Utilization Review Nurse - Remote
3 day ago
Conifer Health Solutions
- Remote: Texas (USA)
- Full time
Utilization ManagementMedical NecessityClinical DocumentationNurse Licensure CompactCost ContainmentHolistic Nursing
Quality Improvement Coordinator - Behavioral Health
Quality Improvement Coordinator - Behavioral Health
8 day ago
Centene Corporation
- Remote: Washington (USA)
- Full time
Behavioral HealthClinical NursingQuality AssessmentTotal Quality ManagementHealth AdministrationProject Management
PB Diagnostic Coder (Coding Specialist lll)
PB Diagnostic Coder (Coding Specialist lll)
13 day ago
Oregon Health & Science University
- Remote: Oregon (USA)
- Full time
ICD 503CppunitClinical DocumentationICD 5033M EncoderCoding Theory
Peer Reviewer - Surgeon (Contract Remote)
Peer Reviewer - Surgeon (Contract Remote)
7 day ago
Mountain Pacific
- Remote: Montana (USA)
- Freelance
Evaluation Of CareGeneral SurgeryHealthcare QualityMedical NecessityPeer Review
Utilization Review Nurse
Utilization Review Nurse
27 day ago
Sidecar Health
- Remote: Florida (USA), Georgia (USA), Kentucky (USA), Ohio (USA)
- Full time
Utilization ManagementMedical GuidelineNursingMedical NecessityOnline CommunicationPrior Authorization
Virtual Utilization Review Specialist - PART TIME WEEKENDS
Virtual Utilization Review Specialist - PART TIME WEEKENDS
2 day ago
Ensemble Health Partners
- Remote: United States
- Part time
Utilization ManagementClinical AssessmentsMedical NecessityNurse Licensure CompactOrganizational StructureNursing Care
Coding Validator Telecommute IP
Coding Validator Telecommute IP
27 day ago
Hasbro Children's
- Remote: Rhode Island (USA)
- Full time
ICD 503CPT CodingData Quality AssessmentMedical NecessityClinical DocumentationHealth Education
Clinical Appeals Nurse Coder
Clinical Appeals Nurse Coder
29 day ago
Blue Cross Blue Shield of Massachusetts
- Remote: Massachusetts (USA)
- Full time
Human Interface GuidelinesAdjudicationMedical NecessityMedical CodingAcute CareNursing
Field Reimbursement Manager
Field Reimbursement Manager
30+ days ago
McKesson Canada
- Remote: Iowa (USA)
- Full time
Reimbursement RegulationsPresentation TrainingProject ManagementMedical NecessityCommercial InsurancesBilling
Clinical Appeals Reviewer
Clinical Appeals Reviewer
2 day ago
AmeriHealth Caritas
- Remote: United States
- Full time
AppealsRegulatory ComplianceMedical NecessityClinical ConsultingMedical Record ManagementInterQual Criteria
Peer Reviewer - Nephrologist (Contract Remote)
Peer Reviewer - Nephrologist (Contract Remote)
8 day ago
Mountain Pacific
- Remote: Montana (USA)
- Freelance
NephrologyEvaluation Of CareHealthcare QualityMedical Necessity
Field Reimbursement Manager
Field Reimbursement Manager
30+ days ago
CoverMyMeds
- Remote: Iowa (USA)
- Full time
Reimbursement RegulationsPresentation TrainingProject ManagementMedical NecessityCommercial InsurancesBilling
LPN – Utilization Management (Shift Care Team)
LPN – Utilization Management (Shift Care Team)
10 day ago
The CKHobbie Group
- Remote: Pennsylvania (USA)
- Full time
Care CoordinationUtilization ManagementPediatric NursingCompliance ManagementHealth PoliciesInternal Documentation
Peer Reviewer - Cardiology (Contract Remote)
Peer Reviewer - Cardiology (Contract Remote)
7 day ago
Mountain Pacific
- Remote: Montana (USA)
- Freelance
Evaluation Of CareCardiologyHealthcare QualityMedical NecessityDepartment Of Defense (DoD) 8500 SeriesVeterans Administration
Family Practice Telecommute Medical Review
Family Practice Telecommute Medical Review
24 day ago
Concentra
- Remote: New Jersey (USA)
- Full time
Utilization ManagementClinical AssessmentsMedical Licensing (Health Law)Medical NecessityManaged CareCredential Manager
Revenue Integrity Coding Specialist, REMOTE, Revenue Integrity Management, FT, 08A-4:30P
Revenue Integrity Coding Specialist, REMOTE, Revenue Integrity Management, FT, 08A-4:30P
16 day ago
Baptist Health
- Remote: Florida (USA)
- Full time
ICD 503CppunitData MiningEncoder ProMedical NecessityOrganizational Structure
Physician Reviewer - (Radiation Oncology, Cardiology, Rheumatology)
Physician Reviewer - (Radiation Oncology, Cardiology, Rheumatology)
1 day ago
Dane Street, LLC
- Remote: United States
- Freelance
Insurance ReviewsMedical NecessityClinical ConsultingInternal DocumentationOphthalmologyObstetrics And Gynaecology
Concurrent Utilization Review Nurse (Work from Home)
Concurrent Utilization Review Nurse (Work from Home)
7 day ago
Bright Health
- Remote: California (USA)
- Full time
Utilization ManagementMedical GuidelineElectronic Health Record ApplicationsMedical NecessityInterQual CriteriaCare Management
PM&R Telecommute Medical Review Stream
PM&R Telecommute Medical Review Stream
24 day ago
Concentra
- Remote: Texas (USA)
- Full time
Utilization ManagementClinical AssessmentsMedical Licensing (Health Law)Credential ManagerManaged CareMedical Necessity
Revenue Integrity Coding Specialist, REMOTE, Revenue Integrity Management, FT, 08A-4:30P
Revenue Integrity Coding Specialist, REMOTE, Revenue Integrity Management, FT, 08A-4:30P
30+ days ago
Baptist Health
- Remote: Florida (USA)
- Full time
ICD 503CppunitData MiningMedical Necessity
Concurrent Utilization Review Nurse (Work from Home)
Concurrent Utilization Review Nurse (Work from Home)
7 day ago
NeueHealth
- Remote: California (USA)
- Full time
Utilization ManagementMedical GuidelineMedical NecessityElectronic Health Record ApplicationsCare ManagementUtilization Management
Clinical Review Clinician - Appeals (RN)
Clinical Review Clinician - Appeals (RN)
1 day ago
Centene Corporation
- Remote: United States
- Full time
Clinical Data AnalysisUtilization ManagementMedical NecessityMedical Record ManagementRegulatory ComplianceCase Assessment
PM&R Telecommute Medical Review Stream
PM&R Telecommute Medical Review Stream
24 day ago
Concentra
- Remote: New Jersey (USA)
- Full time
Utilization ManagementClinical AssessmentsMedical Licensing (Health Law)Managed CareMedical Necessity
Neurologist Telecommute Medical Review Stream
Neurologist Telecommute Medical Review Stream
24 day ago
Concentra
- Remote: New Jersey (USA)
- Full time
Medical Licensing (Health Law)Clinical AssessmentsNeurologyMedical NecessityUtilization ManagementCredential Manager
Clinical Review Coordinator
Clinical Review Coordinator
30+ days ago
Soleo Health
- Remote: California (USA)
- Full time
Clinical Data AnalysisInfusionsPrior AuthorizationMedical NecessityNurse Licensure Compact
Medical Director - Pediatric Otolaryngology- EviCore
Medical Director - Pediatric Otolaryngology- EviCore
21 day ago
Evernorth Health Services
- Remote: Ohio (USA)
- Full time
OtolaryngologyClinical AssessmentsEvidence-Based PracticeComputer SystemsUtilization ManagementMedical Necessity
Neurosurgeon Telecommute Medical Review Stream
Neurosurgeon Telecommute Medical Review Stream
24 day ago
Concentra
- Remote: New Jersey (USA)
- Full time
NeurosurgeryUtilization ManagementClinical AssessmentsMedical NecessityInsurance ReviewsManaged Care
Telecommute Medical Review Stream Physician
Telecommute Medical Review Stream Physician
24 day ago
Concentra
- Remote: Colorado (USA)
- Full time
Utilization ManagementClinical AssessmentsMedical Licensing (Health Law)Managed CareMedical Necessity
Senior Medical Director, Behavioral Health - New Mexico
Senior Medical Director, Behavioral Health - New Mexico
30+ days ago
Magellan Health
- Remote: United States
- Full time
- Senior (5-10 years)
- 222 - 422K
Stakeholder EngagementCost Benefit AnalysisContinuous Quality Improvement (CQI)Care ManagementClinical AuditingHealth Policies
Nurse Reviewer - REMOTE
Nurse Reviewer - REMOTE
30+ days ago
UMass Chan Medical School
- Remote: Massachusetts (USA)
- Full time
Clinical Data AnalysisCare ManagementPrior AuthorizationMedical NecessityNurse Licensure CompactHome Health Care
RN Reviewer 
RN Reviewer
30+ days ago
Cohere Health
- Remote: United States
- Mid-level (2-5 years)
- 28 - 28K
Utilization ManagementNursingInpatient CareQualification Protocols (IQ/OQ/PQ)Prior AuthorizationWeb Standards
REMOTE Registered Nurse - Medical Review Specialist-Bexar County, Texas
REMOTE Registered Nurse - Medical Review Specialist-Bexar County, Texas
30+ days ago
Avosys Technology, Inc.
- Remote: United States, Texas (USA)
- Freelance
- Mid-level (2-5 years)
Internal DocumentationMedical NecessityMedicareClinical Data Analysis
Nurse, Utilization Management Reviewer.
Nurse, Utilization Management Reviewer.
30+ days ago
DCX PH Inc.
- Remote: United States
- Full time
- Mid-level (2-5 years)
Medical NecessityUtilization ManagementMedicareHealth Services ResearchInterQual CriteriaInternal Documentation
Pre-Authorization Registered Nurse
Pre-Authorization Registered Nurse
30+ days ago
Conviva Care Solutions
- Remote: United States, Laos, Louisiana (USA)
- Full time
- Mid-level (2-5 years)
- 37 - 87K
Medical NecessityUtilization ManagementNursingHospital ExperienceRehabilitationNursing Care
Associate Medical Director
Associate Medical Director
30+ days ago
Lifelancer
- Remote: United States, North Carolina (USA)
- Full time
- Senior (5-10 years)
- 146 - 278K
Clinical ConsultingBusiness StrategiesMedical LawProject ManagementHealth PoliciesMedical Necessity
Senior Clinical Audit Subject Matter Expert 
Senior Clinical Audit Subject Matter Expert
15 day ago
Machinify, Inc.
- Remote: United States
- Full time
Diagnosis-Related GroupMedical NecessityClinical AuditingICD 503Clinical DocumentationAuditing
Louisiana-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
Louisiana-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States, Laos
- Full time
Institutional Review Board (IRB)Medical NecessityUtilization ManagementPsychiatryPsychologyDentistry
OTA - Utilization Management Reviewer
OTA - Utilization Management Reviewer
30+ days ago
DCX PH Inc.
- Remote: United States
- Full time
- Mid-level (2-5 years)
Medical NecessityUtilization ManagementService ReviewClinical DocumentationCare Management SoftwareInterQual Criteria
Care Manager
Care Manager
16 day ago
Lucet (formerly New Directions + Tridiuum)
- Remote: United States
- Full time
Care CoordinationEducational AssessmentClinical Social WorkInternal DocumentationBehavioral HealthCrisis Prevention
Patient Access Case Manager
Patient Access Case Manager
21 day ago
Boston Scientific
- Remote: United States
- Full time
AppealsPrior AuthorizationMedical NecessityPain ManagementMedical Record ManagementSoftware Systems
Physician Reviewer, Utilization Management
Physician Reviewer, Utilization Management
30+ days ago
Oscar Health
- Remote: United States
- Junior (1-2 years)
- 211 - 277K
Evidence-Based PracticeClinical AssessmentsMedical NecessityUtilization ManagementManaged CareClinical Practices
Nurse Inpatient Coding Auditor, CIC or CCS certified
Nurse Inpatient Coding Auditor, CIC or CCS certified
30+ days ago
ProgenyHealth, LLC
- Remote: United States, Texas (USA)
- Mid-level (2-5 years)
- 19 - 19K
ICD Coding (ICD-9/ICD-10)Medical NecessityInpatient CodingHuman Interface GuidelinesNursingCppunit
Clinical Reviewer - LPN
Clinical Reviewer - LPN
30+ days ago
TriWest Healthcare Alliance
- Remote: United States, Azerbaijan, Arizona (USA)
- Senior (5-10 years)
- 58 - 74K
Managed CareClinical NursingMedical NecessityUtilization ManagementMedical GuidelineClinic Management Systems
