Remote Medicaid Care Review Specialist
Metaintro, Inc.
Molina Healthcare is seeking a Care Review Processor I to join the CAM team. The role supports members requiring hospitalization or utilization review, verifying eligibility, benefits, and authorization requests while triaging information to healthcare staff.
The position is fully remote with a schedule during training (8–5 p.m. EST) and post-training hours (9–6 p.m. or 10–7 p.m.). Requires 2+ years of relevant experience.
#J-18808-LjbffrVacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Medicaid Care Review Specialist in United States vacancy
- ...professionals specializing in child and youth abuse to contribute to a remote project focused on improving AI systems' understanding of trauma-informed care and mental health support for vulnerable youth. You'll review and improve AI-generated content related to abuse, trauma,...Remote work
YO AI Labs
United States5 days ago - ...Position TitleCare Coordination Specialist (CCS)-Medicaid Incentive Payment ProgramDays - Full TimeCare... ...Summary / Career Interest:The Care Coordination Specialist (CCS) supports... ...initiatives including dual-eligible and remote patient monitoring programs. This position...Remote workWork at officeNight shift
The University of Kansas Health System
Hays, KS4 days ago - ...registered nurse to support medical billing review and utilization reviews. You will review medical... ...to ensure billing accuracy and appropriate care, applying clinical judgment to assess medical necessity. The role is remote, with flexible PTO, health benefits, a 401(k)...Remote workFlexible hours
Partner Engineering and Science
New York, NY1 day ago $27.02 - $48.55 per hour
...Centene is seeking a Clinical Review Nurse - Concurrent Review to perform... ...discharge planning. This role supports Medicaid and Marketplace/Ambetter members in a remote setting. The position offers... ...where applicable, plus 2+ years of acute care experience. #J-18808-LjbffrRemote workHourly payFull timeCentene Corporation
United States1 day ago$30 - $45 per hour
...agency is seeking an Operations Specialist III for a contract... ...This role requires expertise in Medicaid and Medi-Cal operations, along... ...in Epic EHR and Utilization Review. The selected candidate will... ...program metrics. This position is remote and offers a pay range of $30...Remote workHourly payContract workPyramid Consulting
Long Beach, CA1 day ago- ...CoventBridge Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) for a remote role, based from Grove City, OH. The position conducts... ...preferred, and have 2+ years in Medicaid or managed care, plus ICD-10-CM/CPT coding experience. #J-18808-Ljbffr...Remote work
CoventBridge Integrity Systems
Grove City, OH1 day ago $65k - $75k
...Long-Term Care Medicaid SpecialistToday is a new day. At Asbury we're filling it with more... ...processes. The Long-Term Care Medicaid Specialist will also handle Medicaid Pending and Patient... ...are submitted timely and accurately.Reviews Medicaid Pending and Patient Liability...Full timeWork experience placementWork at officeAsbury Communities
Gaithersburg, MD1 day ago- ...CoventBridge Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) to conduct clinical chart reviews for fraud investigations... ...guidelines to determine payment coverage. This position is remote, with occasional on-site audits in OH if needed. You will...Remote work
CoventBridge Integrity Systems
New York, NY18 hours ago - Avēsis is hiring a Bilingual Customer Engagement Specialist for our 100% remote Dental Medicaid Call Center in the United States. You will handle 40-hour weeks, primarily inbound calls, offering compassionate guidance to Medicaid members while protecting privacy and HIPAA...Remote jobHome office
- ...Solution Services seeks a Medical Billing Specialist to support a pediatric urgent care practice in St. Pete, Florida. The role... ...reimbursement while complying with Medicaid requirements. Responsibilities include reviewing provider documentation, billing CPT/ICD-...
Evening Pediatrics
Saint Petersburg, FL1 day ago - LONG TERM CARE MEDICAID BUSINESS OFFICE SPECIALIST Experience in a long-term care facility and knowledge of the healthcare business office environment... ...managed care, and private pay documentation as assigned. Review documents for completeness, accuracy, and required...Work at office
- ...Conduent seeks a Medical Benefits Review Associate to support overpayment programs across Medicare, Medicaid and commercial claims in a fully remote environment. You will review claims, verify eligibility, and document findings while communicating with a remote team....Remote workWork at office
Conduent
Sioux Falls, SD1 day ago - ...NeuroPsychiatric Hospitals in Houston, TX is seeking a Utilization Review Coordinator to coordinate patient services across the continuum of care, promoting efficient utilization, monitoring resources, and collaborating with multidisciplinary teams. The ideal candidate...
NeuroPsychiatric Hospitals
Houston, TX17 hours ago - ...Lafayette, TN is seeking a Full Time Case Manager to coordinate care across interdisciplinary teams, conduct comprehensive patient assessments... ...years of healthcare experience, and proficiency in utilization review processes. You will engage in quality improvement activities,...Full time
MACON HOSPITAL INC
Lafayette, TN3 days ago - ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The... ...requiring clinical expertise and knowledge of Medicaid guidelines. Candidates must have an... ...setting, and the ability to work in a remote environment. Comprehensive benefits are...Remote workContract workWork from home
Mass Digital Health
Quincy, MA1 day ago $85 per hour
...Position: Underpayment & Managed-care Contract Specialist Type: Contract... ...$85/hour Location: Remote Role Responsibilities... ...Medicare Advantage , and Medicaid managed care payer contracts... ...mercor.com PS: Our team reviews applications daily. Please...Remote workDaily paidContract workSummer workMercor
New York, NY27 days ago- ...Health Louisiana program, seeks a Medical Director to advance Medicaid quality, access and outcomes. This work‑from‑home role supports... ...other plans as needed, driving utilization management and care reviews. Eligible physicians will lead with integrity and collaborate...Remote workWork from home
CVS Health
United States4 days ago $60k
...experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This role collaborates with our... ...year. Minimum 3 years nursing and 2 years UM in managed care are expected; Medicare/Medicaid experience is a plus. You will ensure medical necessity...Remote job- ...Psychiatric Hospital in Long Beach, CA, is seeking an Utilization Review professional for on-site, 8-hour shifts. You will review... ...necessity, and coordinate with payers to ensure appropriate level-of-care for both inpatient and outpatient services. The role requires strong...Shift work
Ocean View Psychiatric Hospital
Long Beach, CA1 day ago - ...The University of Kansas Health System is seeking a Care Coordination Specialist (CCS) to support Medicaid Incentive Payment (MIP) Program implementation across rural Kansas practices. You will engage with clinics, coordinate with MCOs, and ensure accurate incentive payments...
The University of Kansas Health System
Hays, KS5 days ago - ...To support Medicaid and Market Place/Ambetter members, the full-time Michigan Licensed Clinical Review Nurse will perform concurrent reviews to evaluate... ...the appropriateness of care, and contribute to discharge planning while working remotely from home. Key responsibilities...Remote workFull timeWork from home
Virtual Vocations Inc
United States3 days ago - Conduent is seeking a Medical Benefits Review Associate for a fully remote role in the United States. The position involves analyzing Medicare, Medicaid, and Commercial claim overpayments and supporting CPIS overpayment programs. You will review claims, verify eligibility...Remote job
$18 per hour
Conduent is seeking a Medical Benefits Review Services Associate II for a fully remote role. Pay starts at $18.00/hour, with consideration based on experience... ...for CPIS overpayment programs related to Medicare, Medicaid and Commercial claims, with data entry and...Remote jobMonday to Friday- Conduent is seeking a Medical Benefits Review Associate II to provide analytical support on Medicare, Medicaid and Commercial claim overpayments. This fully remote role is Monday-Friday, 8:00 AM-4:30 PM EST, with starting pay and a salary range noted below. The position...Remote jobMonday to Friday
- ...Surgical Management Professionals, LLC (SMP) is seeking a Managed Care Analytics Coordinator for a full-time remote role in the United States. You will review payer contracts, analyze claims data, and develop dashboards to identify trends and improvement opportunities...Remote workFull time
Surgical Management Professionals
United States1 day ago $18 per hour
Conduent is seeking a Medical Benefits Review Associate Pay: Starting at $18.00/hour, fully remote. Monday-Friday | 8:00 AM -4:30 PM EST. The role involves analytical support for Medicare, Medicaid, and Commercial claim overpayments, using client claims systems and related...Remote jobMonday to Friday- ...RecruiterForge is hiring a Customer Care Representative to support patients, providers, and healthcare partners from a remote US location. You will handle high-volume calls and... ...service goals. Expect training, performance reviews, and a rewards program, plus comprehensive...Remote work
RecruiterForge
United States3 days ago - ...County Community Hospital located in Missouri seeks a Utilization Review Coordinator (RN) to support a comprehensive review system,... ...compliance, promote efficient resource use, and enhance patient care. The role requires 2+ years of nursing experience, MO RN licensure...
Harrison County Community Hospital
Bethany, MO1 day ago - ...Nido & Affiliates, LLC is seeking a Certified Diabetes Care and Education Specialist for a 1099 remote contract role. The CDCES will guide insulin and other... ...management in coordination with the medical team, review glucometer readings, and educate patients on diabetes...Remote workContract work
Monte Nido & Affiliates
United States5 days ago - ...Humana is seeking a Transition Coordinator (Care Coach 2) to evaluate member needs and guide families toward appropriate care resources. The role involves coordinating transitions across Indiana Medicaid programs and various care settings, with a focus on maintaining optimal...Remote work
Humana
Indiana, PA3 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medicaid Care Review Specialist. Be the first to apply!
Related searches
- caregiver visa sponsorship United States
- caregiver personal care assistant United States
- plant health care specialist United States
- adult caregiver United States
- weekend live in caregiver United States
- caregiver United States
- asleep overnight caregiver United States
- child care specialist United States
- professional caregiver United States
- cna caregiver United States