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
364 jobs
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Director of Substance Use Disorder
Director of Substance Use Disorder
Today
Detroit Wayne Integrated Health Network
- Remote: Michigan (USA)
- Full time
Quality AssessmentSubstance Abuse PreventionGrant ApplicationsContract ManagementGood Clinical Practices (GCP)Budget Management
Healthcare - Medical Director
Healthcare - Medical Director
Today
APN Consulting Inc.
- Remote: United States
- Full time
Utilization ManagementRegulatory ComplianceMedical LawClinical Quality ManagementRegulatory ComplianceMedical Practice Experience
Case Management Assistant II, Work From Home
Case Management Assistant II, Work From Home
1 day ago
Sutter Health
- Remote: Georgia (USA), Nevada (USA), North Carolina (USA), Pennsylvania (USA), Texas (USA)
- Full time
Utilization ManagementDischarge Planning
Healthcare Appeals Associate
Healthcare Appeals Associate
1 day ago
TLNT
- Remote: Mexico
- Full time
Patient Education And CounselingMedical LawCPT CodingInsurance Follow-UpTechnical WritingUtilization Management
Compliance Program Manager (Clinical Audit & Oversight) 
Compliance Program Manager (Clinical Audit & Oversight)
1 day ago
Health Plan of San Joaquin
- Remote: California (USA)
- Full time
Compliance ManagementProject ManagementClinical AuditingRegulatory ComplianceAuditingGrievance Arbitration
RN Coordinator Utilization Management
RN Coordinator Utilization Management
1 day ago
Network Health WI
- Remote: Wisconsin (USA)
- Full time
Care ManagementUtilization ManagementAssessment And AuthorizationClinical AssessmentsNursingManaged Care
Grievance & Appeals Specialist
Grievance & Appeals Specialist
1 day ago
The CGC Group
- Remote: United States
- Fixed term
Utilization ManagementGrievance ArbitrationMedical NecessityCompliance ManagementMedical AbbreviationsMedicare
RN Clinical Review Clinician - Appeals
RN Clinical Review Clinician - Appeals
1 day ago
Centene Corporation
- Remote: United States
- Full time
Utilization ManagementNurse Licensure CompactClinical Data AnalysisMedicareMedical NecessityUtilization Management
Medical/UM Clinical Guideline Writer
Medical/UM Clinical Guideline Writer
1 day ago
New Century Health
- Remote: United States
- Full time
Utilization ManagementMedical GuidelineMedical WritingHospital ExperienceLegislative ProceduresProperty Ownership
Medical/UM Clinical Guideline Writer
Medical/UM Clinical Guideline Writer
1 day ago
Evolent Health
- Remote: United States
- Full time
Utilization ManagementMedical GuidelineMedical WritingHospital ExperienceLearning Content Management Systems (LCMS)
Career Opportunities: Utilization Review Nurse (Remote- Maine RN Only) (30353)
Career Opportunities: Utilization Review Nurse (Remote- Maine RN Only) (30353)
3 day ago
Gainwell Technologies LLC
- Remote: Maine (USA)
- Full time
Utilization ManagementInterQual CriteriaMedical NecessityClinical DocumentationHospital ExperiencePrior Authorization
Transitions of Care - RN
Transitions of Care - RN
3 day ago
Elevance Health
- Remote: Tennessee (USA)
- Full time
Patient Education And CounselingNurse Licensure CompactHealth And Wellness CoachingMotivational InterviewingCare CoordinationCommunicating With Patients
Oracle Utilities MDM Consultant
Oracle Utilities MDM Consultant
4 day ago
Talpro - Leaders in Technology Hiring
- Remote: India
- Full time
Oracle Application Framework (OAF)Java (Programming Language)IBM InfoSphere MDMMeter Data ManagementDevice ManagementUtilization Management
Utilization Review/Appeals Clinician - ABA
Utilization Review/Appeals Clinician - ABA
3 day ago
Centene Corporation
- Remote: Florida (USA)
- Full time
Utilization ManagementBehavioral HealthClinical AssessmentsApplied Behavior AnalysisAnalyticsCommunicating With Patients
Clinical Coding and OASIS Review Manager
Clinical Coding and OASIS Review Manager
4 day ago
BAYADA Home Health Care
- Remote: Texas (USA)
- Full time
ICD 503MedicareMedical CodingUtilization Management
RN Appeals Analyst
RN Appeals Analyst
3 day ago
BlueCross BlueShield of South Carolina
- Remote: Tennessee (USA)
- Full time
Clinical Data AnalysisUtilization ManagementManaged CareMedical NecessityHome Health CareOnline Communication
RN Utilization Management
RN Utilization Management
2 day ago
Arkansas Blue Cross and Blue Shield
- Remote: Florida (USA), Georgia (USA), Illinois (USA), Kansas (USA), Louisiana (USA), Minnesota (USA), Mississippi (USA), Oklahoma (USA), South Carolina (USA), Tennessee (USA), Texas (USA), Virginia (USA), Wisconsin (USA)
- Full time
Clinical Data AnalysisUtilization ManagementNursing EthicsOnline CommunicationAnalyticsCritical Care
HMSA Care Manager - BH, UM Reviewer - Remote Hawaii
HMSA Care Manager - BH, UM Reviewer - Remote Hawaii
4 day ago
Magellan Health
- Remote: Hawaii (USA)
- Full time
Mental Health And Recovery ServicesUtilization ManagementCrisis InterventionAddiction CounselingCare CoordinationDischarge Planning
BH Care Manager, Health Plan, Licensed in CA, Remote
BH Care Manager, Health Plan, Licensed in CA, Remote
2 day ago
Magellan Health
- Remote: California (USA)
- Full time
Behavioral HealthCare ManagementEducational AssessmentCrisis InterventionCare PlanningInpatient Care
Career Opportunities: RN Clinical Systems Trainer (24916)
Career Opportunities: RN Clinical Systems Trainer (24916)
4 day ago
CareOregon
- Remote: Arizona (USA), Idaho (USA), Montana (USA), Nevada (USA), Oregon (USA), Texas (USA), Utah (USA), Washington (USA), Wisconsin (USA)
- Full time
Nurse RegistryMedical GuidelineEmployee OnboardingInterQual CriteriaClinical Data ManagementChange Management
Clinical Coding and OASIS Review Manager
Clinical Coding and OASIS Review Manager
4 day ago
BAYADA Home Health Care
- Remote: Florida (USA)
- Full time
ICD 503MedicareMedical CodingUtilization Management
Quality Improvement Coordinator I
Quality Improvement Coordinator I
1 day ago
Centene Corporation
- Remote: United States
- Full time
Health Care Risk ManagementHEDIS (Healthcare Effectiveness Data And Information Set)Clinical Quality ManagementQuality AssessmentPerformance ManagementAuditing
Clinical Pharmacist, Utilization Management
Clinical Pharmacist, Utilization Management
1 day ago
Rightway
- Remote: United States
- Full time
Utilization ManagementPharmacy Benefit ManagementPharmacist AssistanceHealthcare StrategyHealth Policy DevelopmentPrior Authorization
Associate Director - Clinical Solutions - Care Management/Utilization Management
Associate Director - Clinical Solutions - Care Management/Utilization Management
1 day ago
Guidehouse
- Remote: United States
- Full time
Utilization ManagementCare ManagementClinical PracticesData MiningProject ManagementCustomer Relationship Management
Behavioral Health Care Manager - Licensed in NJ, LCSW/LMFT/LPC/LP, Mon thru Fri, 11:00 am EST to 7:30 p.m. EST (Remote - DE, NJ, NY, PA)
Behavioral Health Care Manager - Licensed in NJ, LCSW/LMFT/LPC/LP, Mon thru Fri, 11:00 am EST to 7:30 p.m. EST (Remote - DE, NJ, NY, PA)
8 day ago
AmeriHealth Caritas
- Remote: Delaware (USA), New Jersey (USA), New York (USA), Pennsylvania (USA)
- Full time
Competency AssessmentClinical Social WorkCare CoordinationCultural Competency TrainingCrisis ManagementGood Documentation Practices
UM Administration Coordinator (Kentucky Medicaid)
UM Administration Coordinator (Kentucky Medicaid)
3 day ago
Humana
- Remote: Illinois (USA), Indiana (USA), Missouri (USA), Ohio (USA), Tennessee (USA), Virginia (USA), West Virginia (USA)
- Full time
Utilization ManagementMedical AbbreviationsICD Coding (ICD-9/ICD-10)Help Desk SupportPrior AuthorizationUtilization Management
Utilization Management Intake Coordinator I
Utilization Management Intake Coordinator I
2 day ago
Arkansas Blue Cross and Blue Shield
- Remote: Florida (USA), Georgia (USA), Illinois (USA), Kansas (USA), Louisiana (USA), Minnesota (USA), Mississippi (USA), Oklahoma (USA), South Carolina (USA), Tennessee (USA), Texas (USA), Virginia (USA), Wisconsin (USA)
- Full time
Utilization ManagementData EntryOnline Communication
Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote
5 day ago
Evernorth Health Services
- Remote: Connecticut (USA)
- Full time
Utilization ManagementClinical AssessmentsAcute Care NursingLegal KnowledgeMedical Licensing (Health Law)
Clinical Integration Liaison - Licensed/Remote in CA
Clinical Integration Liaison - Licensed/Remote in CA
11 day ago
Magellan Health
- Remote: California (USA)
- Full time
Clinical Data ExchangeUtilization ManagementProject ManagementMental Health EducationAddiction CounselingMental Health Counseling
Vendor Audit and Compliance Specialist
Vendor Audit and Compliance Specialist
Just Now
Cambia Health Solutions
- Remote: Idaho (USA), Oregon (USA), Utah (USA), Washington (USA)
- Full time
Technical AuditCompliance ManagementAnalyticsProject ManagementHealth AdministrationRegulatory Compliance
Medical Director
Medical Director
3 day ago
Highmark Health
- Remote: Alabama (USA), Alaska (USA), Arizona (USA), Arkansas (USA), California (USA), Colorado (USA), Connecticut (USA), Delaware (USA), District of Columbia (USA), Florida (USA), Georgia (USA), Hawaii (USA), Idaho (USA), Illinois (USA), Indiana (USA)
- Full time
Utilization ManagementMedical ManagementCare ManagementClinical ConsultingOnline CommunicationMedical Software
US Registered Nurse
US Registered Nurse
4 day ago
Nezda Technologies Inc.
- Remote: Philippines
- Full time
Utilization ManagementInternational Laws
Supervisor, Clinical Review
Supervisor, Clinical Review
30+ days ago
Comagine Health
- Remote: United Kingdom
- Senior (5-10 years)
- 81 - 113K
Medical ManagementMedicaid Management Information Systems (MMIS)Recruitment StrategiesUtilization ManagementInterQual CriteriaOrganizational Structure
National Medical Director
National Medical Director
30+ days ago
CorVel Corporation
- Remote: Virginia (USA)
- Part time
- Expert & Leadership (>10 years)
Regulatory ComplianceUtilization ManagementOnline CommunicationCPT CodingProject CollaborationClinical Documentation
USRN
USRN
4 day ago
Nezda Technologies Inc.
- Remote: Philippines
- Full time
Clinical AssessmentsUtilization ManagementWorkers' Compensation Claims
Utilization Management Registered Nurse, MI - Remote
Utilization Management Registered Nurse, MI - Remote
5 day ago
McLaren Health Care
- Remote: Michigan (USA)
- Full time
Utilization ManagementNursingManaged CareCare ManagementBehavioral Change TheoriesMedical Management
Utilization Review Clinician (RN, PT, OT) - Oregon
Utilization Review Clinician (RN, PT, OT) - Oregon
7 day ago
WellSky
- Remote: Oregon (USA)
- Full time
Care CoordinationUtilization ManagementMedical GuidelineNursingInterQual CriteriaMedical Software
Lead Actuarial Analyst
Lead Actuarial Analyst
2 day ago
Cohere Health
- Remote: United States
- Full time
Prior AuthorizationFinancial ModelingHealthcare AnalyticsCost Benefit AnalysisAnalyticsSQL (Programming Language)
Physician Utilization Reviewer (Medical Director)
Physician Utilization Reviewer (Medical Director)
8 day ago
Medical Review Institute
- Remote: Utah (USA)
- Full time
Clinical Data AnalysisUtilization ManagementClinical MedicineCommunity AdvocacyFamily MedicineHospital Experience
Utilization Review Clinician - Behavioral Health
Utilization Review Clinician - Behavioral Health
3 day ago
Centene Corporation
- Remote: Florida (USA), Georgia (USA), North Carolina (USA)
- Full time
Clinical Data AnalysisUtilization ManagementMental Health AssessmentsSubstance Abuse AssessmentsDischarge PlanningClient Education
Medical Director - Medical Oncology - eviCore - Remote
Medical Director - Medical Oncology - eviCore - Remote
13 day ago
Evernorth Health Services
- Remote: Ohio (USA)
- Full time
Evidence-Based PracticeClinical AssessmentsMedical OncologyCare ManagementMedical Licensing (Health Law)Utilization Management
Utilization Management Nurse – Behavioral Health Focus (Remote)
Utilization Management Nurse – Behavioral Health Focus (Remote)
5 day ago
Morgan Stephens
- Remote: Arizona (USA), Florida (USA), Georgia (USA), Idaho (USA), Iowa (USA), Kentucky (USA), Michigan (USA), Nebraska (USA), New Mexico (USA), New York (USA), Texas (USA), Utah (USA), Washington (USA), Wisconsin (USA)
- Full time
Utilization ManagementBehavioral HealthNurse Licensure CompactInterQual CriteriaDigital File ManagementManaged Care
Telecommute Medical Review Stream Physician
Telecommute Medical Review Stream Physician
26 day ago
Concentra
- Remote: New Mexico (USA)
- Full time
Utilization ManagementClinical AssessmentsMedical Licensing (Health Law)Business NegotiationAnesthesiologyNeurosurgery
Registered Nurse-Access Care- UMC-Remote Work-36 Hours-Midnights-Detroit
Registered Nurse-Access Care- UMC-Remote Work-36 Hours-Midnights-Detroit
30+ days ago
Henry Ford Health
- Remote: Michigan (USA)
- Full time
Utilization ManagementNursingCare ManagementClinical AssessmentsEvidence-Based PracticeRegulatory Compliance
Utilization Review Nurse
Utilization Review Nurse
28 day ago
Sidecar Health
- Remote: Florida (USA), Georgia (USA), Kentucky (USA), Ohio (USA)
- Full time
Utilization ManagementMedical GuidelineNursingMedical NecessityOnline CommunicationPrior Authorization
Utilization Review Nurse
Utilization Review Nurse
30+ days ago
LanceSoft, Inc.
- Remote: Michigan (USA)
Discharge PlanningCare CoordinationClinical AssessmentsUtilization ManagementInterQual Criteria
Payment Integrity Clinician - (Remote)
Payment Integrity Clinician - (Remote)
15 day ago
Highmark Health
- Remote: Pennsylvania (USA)
- Full time
Coding TheoryInsurance ReviewsClinical AssessmentsAnalyticsClient EducationMedical Record Management
Utilization Management Nurse (MLTC Focus) - Remote
Utilization Management Nurse (MLTC Focus) - Remote
14 day ago
Morgan Stephens
- Remote: New York (USA)
- Part time
MedicaidUtilization ManagementNurse Licensure CompactClinical Data AnalysisInpatient CareCare Management
Utilization Review Nurse - Remote
Utilization Review Nurse - Remote
5 day ago
Conifer Health Solutions
- Remote: Texas (USA)
- Full time
Utilization ManagementMedical NecessityClinical DocumentationNurse Licensure CompactCost ContainmentHolistic Nursing
Field Medical Director, Oncology
Field Medical Director, Oncology
2 day ago
New Century Health
- Remote: United States
- Full time
Clinical Data AnalysisUtilization ManagementMedical OncologyMedical Licensing (Health Law)Continuous TrainingInternal Documentation
