Review clinical cases to make coverage determinations using evidence-based guidelines. Collaborate with providers and care teams to coordinate appropriate treatment and improve member outcomes.
Online Jobs (223,002)
Review clinical cases to make coverage determinations using evidence-based guidelines. Collaborate with providers and care teams to coordinate appropriate treatment and improve member outcomes.
Senior Applied Scientist, Search & Information Retrieval
Thomson Reuters
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Full Time
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Yesterday
Thomson Reuters
Design, build, and deploy production-grade neural search and retrieval systems for legal and professional content. Develop models for query understanding and re-ranking while building comprehensive evaluation frameworks using expert and synthetic data.
Responsible for identifying, assessing, and mitigating organizational risks to ensure ethical business activities and regulatory compliance. The role focuses on reducing patient harm through incident reporting, root cause analysis, and the development of safety policies.
Evaluation and Research Scientist
University of Chicago
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Full Time
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Yesterday
University of Chicago
Lead and support program evaluation and research projects focused on STEM, data science, and AI education from kindergarten through adulthood. Manage the full research lifecycle, including project design, data collection, analysis, and the preparation of reports and funding proposals.
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Clinical Finance Case Management - RN
The Ohio State University
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Full Time
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Yesterday
The Ohio State University
The CFCM-RN secures complex pre-authorizations and manages clinical appeals to prevent and resolve denials. They apply medical necessity guidelines to determine appropriate levels of care and serve as subject matter experts for payer requirements.
Support pharmacy clients by delivering data-driven strategic recommendations and operational improvements to enhance financial performance. Lead the development of innovative solutions and manage project execution across multiple GPO and Pharmacy Enterprise engagements.
Lead and deliver complex, strategic projects across various business functions including IT, HR, and Finance. Responsible for project governance, financial oversight, stakeholder alignment, and driving organizational change management.
Affiliate Partnerships & Revenue Manager - FOUR (Remote)
Progressive Leasing
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Full Time
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Yesterday
Progressive Leasing
Own and grow the affiliate revenue stream by optimizing existing partner performance and negotiating stronger commercial terms. Build AI-assisted systems, dashboards, and automated workflows to monitor partner health and maximize GMV contribution.
Associate Director, Cancer Center Partnerships
American Chemical Society
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Full Time
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Yesterday
American Chemical Society
The Associate Director cultivates strategic partnerships with NCI-designated cancer centers and healthcare systems to advance ACS priorities. They lead the implementation of pillar priorities to improve cancer care access, equity, and patient outcomes.
Associate Director, Cancer Center Partnerships
American Chemical Society
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Full Time
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Yesterday
American Chemical Society
The Associate Director cultivates strategic partnerships with NCI-designated cancer centers and healthcare systems to advance ACS priorities. They lead the implementation of pillar priorities to improve cancer care access, equity, and patient outcomes.
Lead long-term planning, budgeting, and forecasting to support business strategy and financial goals. Provide strategic financial insights, M&A modeling, and commercial assessments to optimize decision-making and organizational performance.
The Property Claims Advisor is responsible for interpreting insurance policies, determining coverages, and settling homeowner claims of moderate to high complexity. The role involves managing a caseload, negotiating settlements, and collaborating with adjusters and vendors to solve customer problems.
The role involves driving revenue growth by selling Identity Security solutions and managing the full sales cycle from discovery to closing. The executive will lead virtual teams and collaborate with partners to execute territory and business plans.
Lead the development and execution of GTM programs, sales plays, and field activation strategies for Sales Cloud and Agentforce. Collaborate across product, sales, and enablement teams to create high-impact sales tools and ensure field readiness.
Acts as a liaison between members and community-based service providers to facilitate quality, cost-effective care. Responsibilities include monitoring member wellbeing through home visits, adjusting care plans, and collaborating with stakeholders to resolve barriers to medical care.
The adjuster is responsible for investigating, evaluating, and quantifying insurance claims to determine coverage and liability. They manage the full claims lifecycle, including interviewing witnesses, negotiating settlements, and maintaining accurate records in company systems.
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The specialist researches and interprets HCPCS, CPT, and ICD-10 coding to support prior authorization requirements and clinical policy initiatives. They collaborate with clinical and operational teams to ensure coding recommendations are accurate and compliant across various lines of business.
Act as the first line of technical defense by providing remote troubleshooting and support for bakery equipment customers via phone and remote apps. Manage the ticketing queue and support the Service Manager with administrative duties and training documentation.
The Care Partner serves as the primary point of contact for caregivers, managing their journey from recruitment and onboarding to placement and ongoing support. They are responsible for matching caregivers with members, coordinating schedules, and providing coaching to ensure high-quality care delivery.
Senior Director, AI Engineering -Agentic AI Platform(Remote Eligible)
Capital One
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Full Time
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Yesterday
Capital One
Lead the design and deployment of an Agentic AI platform, overseeing components like foundation model training, inference, and guardrails. Partner with cross-functional teams to deliver AI-powered products and manage the technical vision and long-term roadmap for foundational AI systems.
Clinical Triage Specialist (LPN/RN) - Women's Care (PA & NJ Residents Only)
St. Luke's University Health Network
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Full Time
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Yesterday
St. Luke's University Health Network
The specialist is responsible for assessing and triaging patient calls using approved nursing protocols to ensure appropriate levels of care. They serve as a clinical resource for team members and manage escalated electronic patient messages.
Regional Manager - Surgical Technologies - Arctic Range (MN, SD, ND, WI, NE)
Stryker
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Full Time
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Yesterday
Stryker
Strategically plan and coordinate selling activities while supervising and developing a team of sales representatives. Collaborate with the Director of Sales to maximize regional opportunities and exceed performance goals.
Handle customer inquiries via phone, email, and live chat regarding e-commerce and loyalty programs. Manage order fulfillment, returns, refunds, and coordinate with logistics teams to ensure client needs are met.
Director, Data Product Coordination Lead (Data & Technology)
Parexel
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Full Time
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Yesterday
Parexel
Orchestrate enterprise data initiatives and align data products across clinical, corporate, and commercial business domains. Lead a team of coordinators to manage intake, prioritization, and end-to-end delivery across data ingestion, engineering, and distribution functions.
National Director, External Expert Engagement, Neuroscience - REMOTE
Novartis
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Full Time
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Yesterday
Novartis
Lead the strategy for external expert engagement within the Neuroscience therapeutic area to shape business strategy and brand positioning. Collaborate across cross-functional teams to translate healthcare insights into innovative engagement strategies and manage relationships with Medical Experts.
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Lead the planning, design, and execution of natural gas transmission and midstream energy infrastructure projects. This includes performing hydraulic modeling, executing engineering calculations, and coordinating with multidisciplinary teams to ensure regulatory compliance.
The engineer provides technical support through reactive and planned maintenance, fault diagnosis, and commissioning of electrical systems. They act as a key technical representative on customer sites to ensure industrial power and automation systems operate at peak performance.
The Senior Analyst manages forecasting and budget models while ensuring the reliability of the data layer for planning cycles. They conduct deep-dive investigations and translate complex data into actionable narratives for leadership.
Regional Commercial Manager - India
Engineers and Constructors International Inc.
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Full Time
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Yesterday
Engineers and Constructors International Inc.
Drive the expansion of technology licensing business in India by identifying and securing high-value greenfield and brownfield projects. Establish executive relationships with petrochemical producers and refiners to position the company as a trusted partner.
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