Remote Utilization Management Jobs
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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
348 jobs
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Board Certified-Texas Licensed Physician Reviewer-Multiple Specialties
Board Certified-Texas Licensed Physician Reviewer-Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States, Texas (USA)
- Full time
Medical Licensing (Health Law)Medical NecessityUtilization Management
Connecticut-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
Connecticut-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States
- Fixed term
Medical NecessityUtilization ManagementClinical AssessmentsCare Management
Physician Advisor
Physician Advisor
30+ days ago
Med-Metrix
- Remote: United States
- Full time
- Mid-level (2-5 years)
Patient SafetyUtilization ManagementEmergency Medical DispatchInterQual CriteriaMedical Licensing (Health Law)Physician Credentialing
Population Health Program Nurse
Population Health Program Nurse
13 day ago
Trillium Health Resources
- Remote: United States
- Full time
Data MiningPublic HealthClinical ConsultingUtilization ManagementNursingDischarge Planning
Weekend Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote
Weekend Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote
30+ days ago
Healthfirst
- Remote: United States, Laos, Kansas (USA), Minnesota (USA), Wyoming (USA)
- Full time
- 71 - 116K
Utilization ManagementClinical InvestigationsCompliance ManagementHealthcare QualityDental HygieneAppeals
Central Denials Unit Coordinator
Central Denials Unit Coordinator
30+ days ago
Russell Tobin
- Remote: United States, California (USA)
- Fixed term
- Senior (5-10 years)
- 38 - 42K
Internal DocumentationCPT CodingUtilization ManagementMedical Licensing (Health Law)Electronic ReferralsICD Coding (ICD-9/ICD-10)
Financial Analyst (Remote)
Financial Analyst (Remote)
30+ days ago
HR Prospect
- Remote: United States, New Jersey (USA)
- Full time
- Junior (1-2 years)
Client ServicesCorporate Financial ReportingUtilization ManagementVendor ManagementGroup InsuranceAnalytics
Utilization Review Specialist
Utilization Review Specialist
21 day ago
Assembly Health
- Remote: United States
- Full time
Utilization ManagementBehavioral HealthHospital ExperienceAnalyticsMedical NecessityBilling
Board Certified NC - Licensed Physician Reviewers - Multiple Specialties
Board Certified NC - Licensed Physician Reviewers - Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States, North Carolina (USA)
Medical Licensing (Health Law)Medical NecessityUtilization ManagementOrthopedics
Medical Director- South Central
Medical Director- South Central
30+ days ago
Conviva Care Solutions
- Remote: United States
- Full time
- Senior (5-10 years)
- 223 - 313K
Utilization ManagementClinical AssessmentsRegulatory ComplianceMedical GuidelineMedical Practice ExperienceDischarge Planning
Medical Case Manager II - RN (Bilingual English-Spanish)
Medical Case Manager II - RN (Bilingual English-Spanish)
30+ days ago
CorVel Corporation
- Remote: United States, California (USA)
- Mid-level (2-5 years)
- 58 - 89K
NursingOrthopedicsNeurologyRehabilitationManaged CareClinical Medicine
Clinical Operations Manager
Clinical Operations Manager
27 day ago
Gravie
- Remote: United States
- Full time
General SurgeryHealthcare StrategyCost ContainmentUtilization ManagementData MiningTransitional Care
Staff Vice President PHCO UM Operations Support
Staff Vice President PHCO UM Operations Support
30+ days ago
Centene Corporation
- Remote: United States
- Full time
- Senior (5-10 years)
- 182 - 345K
Utilization ManagementRegulatory ComplianceBusiness OperationsBusiness DevelopmentStakeholder CommunicationsProduct Software Implementation Method
Autism Services Navigator, Case Manager, RN/LCSW
Autism Services Navigator, Case Manager, RN/LCSW
30+ days ago
TriWest Healthcare Alliance
- Remote: United States, Azerbaijan, Arizona (USA)
- Mid-level (2-5 years)
- 81 - 103K
Autism Spectrum DisordersBehavioral HealthMedical CodingHealth AdministrationTri-careHealth Care Finance Administration (HCFA) Regulations
Care Coordinator- CISC
Care Coordinator- CISC
30+ days ago
Magellan Health
- Remote: United States, New Mexico (USA)
- Full time
- Mid-level (2-5 years)
- 50 - 75K
Internal DocumentationNursingClinical Social WorkProject CollaborationCost Benefit AnalysisCare Coordination
Remote Marketplace Medical Director
Remote Marketplace Medical Director
20 day ago
Centene Corporation
- Remote: United States
- Full time
Clinical GovernanceUtilization ManagementClinical AssessmentsQuality AssessmentCare CoordinationMedical Necessity
Board Certified-Colorado Licensed Physician Reviewers-Multiple Specialties
Board Certified-Colorado Licensed Physician Reviewers-Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States
- Full time
Medical NecessityUtilization ManagementGovernment Contracting
Medical Director
Medical Director
30+ days ago
WellSense Health Plan
- Remote: United States, Massachusetts (USA)
- Expert & Leadership (>10 years)
Medical ManagementUtilization ManagementInterQual CriteriaMedical Record ManagementMedicarePrior Authorization
Senior Manager, Medical Policy
Senior Manager, Medical Policy
30+ days ago
Gold Coast Health Plan
- Remote: United States, California (USA)
- Full time
- Senior (5-10 years)
Utilization ManagementHealth Policy DevelopmentHealthcare AnalyticsNurse Licensure CompactMedical CodingManaged Care
Weekend RN Reviewer 
Weekend RN Reviewer
30+ days ago
Cohere Health
- Remote: United States
- Mid-level (2-5 years)
- 28 - 28K
Clinical MedicineUtilization ManagementNursingMedical NecessityInternal DocumentationMedical Practice Experience
Care Manager (UM/UR) - Remote, Idaho Licensed
Care Manager (UM/UR) - Remote, Idaho Licensed
30+ days ago
Magellan Health
- Remote: United States
- Full time
- Mid-level (2-5 years)
- 58 - 93K
Project CollaborationInpatient CareOrganizational StructureUtilization ManagementAnalyticsClinical Data Analysis
Provider Engagement Account Manager
Provider Engagement Account Manager
19 day ago
Sunshine Health
- Remote: United States
- Full time
Provider ModelAccount ManagementQuality AssessmentClaims And Litigation ManagementData EntryProject Management
Part-Time Weekend Medical Director
Part-Time Weekend Medical Director
30+ days ago
Centene Corporation
- Remote: United States
- Full time
- Expert & Leadership (>10 years)
- 231 - 440K
Clinical ConsultingUtilization ManagementRegulatory ComplianceCare CoordinationCost ContainmentProvider Network Management
Reviewer III, Medical
Reviewer III, Medical
30+ days ago
Experis
- Remote: United States, South Carolina (USA)
- Mid-level (2-5 years)
- 57 - 57K
Medical GuidelineClinical AssessmentsMedical AbbreviationsProcedure CodesUtilization ManagementClinical Assessments
Health Plan Senior Business Analyst
Health Plan Senior Business Analyst
29 day ago
Samaritan Health Services
- Remote: United States
- Full time
Database DesignSQL (Programming Language)Business AnalysisProject ManagementData ManagementComputer Science
Remote Registered Nurse (RN) Case Manager
Remote Registered Nurse (RN) Case Manager
30+ days ago
PharmaCord
- Remote: United States, Colorado (USA)
- Mid-level (2-5 years)
Clinical NursingCall Center ExperienceTriageUtilization ManagementNursing ResearchCare Management
Nurse Liaison - Post Acute Care Rochester, NY Sign on Bonus!
Nurse Liaison - Post Acute Care Rochester, NY Sign on Bonus!
30+ days ago
CareCentrix
- Remote: United States, New York (USA)
- Full time
Utilization ManagementNursingElderly CareSocial InfluencesTask ManagementClinical Assessments
Financial Analyst (Remote)
Financial Analyst (Remote)
30+ days ago
HR Prospect
- Remote: United States, New Jersey (USA)
- Full time
Client ServicesCorporate Financial ReportingGroup InsuranceUtilization ManagementAnalytics
Care Management Associate I (Appeals)
Care Management Associate I (Appeals)
30+ days ago
NYC Health + Hospitals
- Remote: United States, New York (USA)
- Mid-level (2-5 years)
ICD 503CppunitAppealsData EntryCall Center ExperienceUtilization Management
Care Management Associate I (Appeals)
Care Management Associate I (Appeals)
30+ days ago
NYC Health + Hospitals
- Remote: United States, New York (USA)
- Mid-level (2-5 years)
ICD 503CppunitMedical AbbreviationsAppealsUtilization ManagementData Entry
PTA - Utilization Management Reviewer
PTA - Utilization Management Reviewer
30+ days ago
DCX PH Inc.
- Remote: United States
- Full time
- Mid-level (2-5 years)
Medical NecessityInterQual CriteriaService ReviewClinical DocumentationCare Management SoftwareUtilization Management
Engagement Manager - Provider Network Management
Engagement Manager - Provider Network Management
27 day ago
WellSky
- Remote: United States
- Full time
Utilization ManagementClient EducationAnalyticsDevelop NetworksMedical Record ManagementEvidence-Based Practice
Registered Nurse (RN), Utilization Review MediGold Health Plan - Remote
Registered Nurse (RN), Utilization Review MediGold Health Plan - Remote
30+ days ago
Trinity Health
- Remote: United States
- Full time
- Mid-level (2-5 years)
Clinical AssessmentsUtilization ManagementManaged CareNursing CareCCURE (Security And Event Management System)Organizational Structure
VP, PHCO Utilization Management Medicaid & Marketplace
VP, PHCO Utilization Management Medicaid & Marketplace
26 day ago
Centene Corporation
- Remote: United States
- Full time
Strategic LeadershipUtilization ManagementRegulatory ComplianceAuditingProvider ModelPrior Authorization
Denials Management Specialist (RN required), Per Diem. Remote within local geography.
Denials Management Specialist (RN required), Per Diem. Remote within local geography.
30+ days ago
St. Luke's University Health Network
- Remote: United States, Pennsylvania (USA)
- Freelance
- Mid-level (2-5 years)
AppealsClinical NursingCommercial InsurancesMedical NecessityUtilization ManagementCare Management
Care Team Member - LPN/LVN - Remote - MST Time Zone (Compact licensed required)
Care Team Member - LPN/LVN - Remote - MST Time Zone (Compact licensed required)
30+ days ago
Optimize Health
- Remote: United States
- Full time
- Mid-level (2-5 years)
Motivational InterviewingUtilization ManagementMotivational SpeakingEmotional SupportCare CoordinationBehavioral Change Theories
RN Outpatient Reviewer, Precertification Operations
RN Outpatient Reviewer, Precertification Operations
30+ days ago
Point32Health
- Remote: United States
- Full time
Clinical InformaticsUtilization ManagementBenefits AdministrationMedical NecessityNursing
Clinical Documentation Specialist- WMCG
Clinical Documentation Specialist- WMCG
30+ days ago
Wellstar Health System
- Remote: United States
- Full time
Clinical DocumentationCoding TheoryLine ChartRegulatory ComplianceReimbursement RegulationsSurgical Services
Medical Director, Denials Management
Medical Director, Denials Management
30+ days ago
CorroHealth
- Remote: United States
- Full time
- Senior (5-10 years)
Clinical MedicineUtilization ManagementInternal MedicineGeneral SurgeryEmergency MedicineCritical Care
Senior Clinical Documentation Improvement (CDI) Specialist
Senior Clinical Documentation Improvement (CDI) Specialist
30+ days ago
UPMC
- Remote: United States, Panama, Pennsylvania (USA)
- Senior (5-10 years)
Medical CodingProspective Payment SystemsMedical Record ManagementAcute Care NursingRemedial EducationUtilization Management
Nurse Liaison - Post Acute Care - Jacksonville, FL Sign on bonus!
Nurse Liaison - Post Acute Care - Jacksonville, FL Sign on bonus!
30+ days ago
CareCentrix
- Remote: United States, Florida (USA)
- Full time
Clinical MedicineUtilization ManagementNursingElderly CareUtilization ManagementSocial Influences
Physician Advisor
Physician Advisor
30+ days ago
Ensemble Health Partners
- Remote: United States
- Full time
Utilization ManagementData ManagementPeer ReviewPatient SafetyEpic EMRMedical Licensing (Health Law)
Nurse Case Manager II
Nurse Case Manager II
30+ days ago
US Tech Solutions
- Remote: United States
- Fixed term
- Mid-level (2-5 years)
Utilization ManagementClinical PracticesCare Management
Board Certified-New York Licensed Physician Reviewers-Multiple Specialties
Board Certified-New York Licensed Physician Reviewers-Multiple Specialties
30+ days ago
Dane Street, LLC
- Remote: United States, New York (USA)
- Full time
Utilization ManagementMedical NecessityNeurologyNeurosurgeryOrthopedics
Board Certified Endocrinologist Physician Advisor, Disability Peer Review
Board Certified Endocrinologist Physician Advisor, Disability Peer Review
30+ days ago
Dane Street, LLC
- Remote: United States
- Freelance
Peer-To-PeerClinical ConsultingDisability ManagementUtilization ManagementMedical Record Management
Licensed Care Coordinator - New Mexico
Licensed Care Coordinator - New Mexico
30+ days ago
Magellan Health
- Remote: United States
- Full time
- Mid-level (2-5 years)
Occupational HealthHome Health CareUtilization ManagementLong-Term CarePublic Health
Clinical Quality Assurance Coordinator
Clinical Quality Assurance Coordinator
30+ days ago
AllMed Healthcare Management
- Remote: United States, Oregon (USA)
- Full time
- Expert & Leadership (>10 years)
Nurse Licensure CompactPhysiologyUtilization ManagementLaboratory ExperimentationPharmaceuticalsAnatomy
Appeals Res Analyst I
Appeals Res Analyst I
7 day ago
Horizon Blue Cross Blue Shield of New Jersey
- Remote: New Jersey (USA)
- Full time
AppealsUtilization ManagementCPT CodingICD Coding (ICD-9/ICD-10)
