Serve as a physician match reviewer for imaging cases to ensure medical necessity and compliance with URAC and NCQA guidelines. Conduct peer-to-peer discussions with providers to provide clinical rationale for determinations and appeals.
Remote Healthcare Jobs in United States (10,101)
Remote in = United States
Job category = Healthcare
Serve as a physician match reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Principal, Clinical Strategy and Program Development
CenterWell
·
Full Time
·
3 Weeks Ago
CenterWell
Lead the strategic direction and execution of Care Integration programs, focusing on High Risk Patient Management and Transitions of Care. Collaborate with IT, Product, and Analytics teams to develop and manage the tooling and platforms that support care delivery for high-complexity senior patients.
Oversee the strategic delivery and operation of clinical technology platforms, including Epic EHR and AI-enabled tools, for the PACE platform. Lead the applications team to ensure regulatory compliance with HIPAA and SOX while driving technology-enabled care transformation.
Lead the design and evolution of clinical and digital care management offerings as a subject matter expert. Collaborate with growth and product teams to align clinical strategy with client needs and drive go-to-market efforts.
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Conduct initial evaluations and develop collaborative treatment plans involving medication and therapy for clients. Provide ongoing monthly follow-ups and various modalities of talk therapy to achieve treatment goals.
$18-$21/HR WFH - Licensed Health Insurance Agent Seasonal - YL
MarketSource
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Part Time
·
3 Weeks Ago
MarketSource
The agent is responsible for handling inbound and outbound calls to assist members with health insurance plan modifications, updates, and enrollments. The role focuses on driving member engagement and retention through high-quality customer service and sales techniques.
RN - Utilization Management
Spectrum Healthcare Resources
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Full Time
·
3 Weeks Ago
Spectrum Healthcare Resources
The nurse will review cases and educate patients on appropriate care to manage healthcare costs for active duty dependents and retirees. This role involves working remotely to ensure efficient utilization of healthcare resources.
Remote Registered Nurse (RN) – Principal Care Management (PCM)
Elaya Health
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Full Time
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3 Weeks Ago
Elaya Health
The RN will review patient charts and coordinate care between providers, pharmacies, and families for nursing home residents. They are responsible for documenting interactions and managing chronic conditions in compliance with CMS guidelines.
Remote Registered Nurse (RN) – Principal Care Management (PCM)
Elaya Health
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Full Time
·
3 Weeks Ago
Elaya Health
The RN will review patient charts and coordinate care between providers, pharmacies, and families for nursing home residents. They are responsible for documenting interactions and managing chronic conditions in compliance with CMS guidelines.
Remote Registered Nurse (RN) – Principal Care Management (PCM)
Elaya Health
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Full Time
·
3 Weeks Ago
Elaya Health
The RN will review patient charts and coordinate care between providers, pharmacies, and families for nursing home residents. They are responsible for documenting interactions and managing chronic conditions in compliance with CMS guidelines.
The Clinical Trial Manager oversees site management, monitoring oversight, and operational activities to ensure compliance with GCP and regulatory requirements. They partner with leadership to drive study execution, manage site engagement, and provide guidance to CRAs.
Virtual Primary Care Associate Medical Director
Cigna Healthcare
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Full Time
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3 Weeks Ago
Cigna Healthcare
Assists the Medical Director in managing the Virtual Primary Care service line, focusing on clinical quality, provider lifecycle, and care pathway development. Maintains 30% of time in direct patient care while providing leadership and consultation to clinical staff.
Region Director Physician Recruitment-Onboarding-Cntrl
CommonSpirit Health
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Full Time
·
3 Weeks Ago
CommonSpirit Health
Provide executive leadership and strategic direction for physician recruitment and onboarding across a designated region. Oversee the full talent acquisition lifecycle, including market analysis, contract negotiation, and alignment with organizational growth goals.
Conduct phone screens and comprehensive clinical evaluations to determine eligibility for pediatric anxiety and OCD care. Provide patient education and generate detailed documentation to ensure seamless transitions to the care team.
Provide professional mental health counseling to adults, couples, or teens via an online platform. Focus on direct client care while utilizing the platform's administrative support to manage caseloads.
Provide expert mental health counseling to adults, couples, or teens via an online platform. Manage a clinical caseload while maintaining autonomy over clinical decisions.
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Provide professional mental health therapy to adults, couples, or teens via an online platform. Focus on client care while maintaining autonomy over clinical decisions.
Sr. Manager, Clinical Trial Payments – Contractor - 3-6 Months
Arcus Biosciences
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Full Time
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3 Weeks Ago
Arcus Biosciences
Oversees site contracts, grants, and payments for full-service CRO partnerships while ensuring global consistency in budgeting and financial controls. Responsible for maintaining compliance with FMV and Sunshine/Open Payments regulations and managing just-in-time CRO funding.
The Clinical Trial Central Screener provides centralized support for patient screening across a network of oncology practices. Key duties include identifying clinical trial candidates, performing remote chart reviews, and collaborating with cross-functional teams to optimize the Genospace software platform.
Clinical Trial Central Screener
Sarah Cannon Research Institute
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Full Time
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3 Weeks Ago
Sarah Cannon Research Institute
The Clinical Trial Central Screener provides centralized support for patient screening across a network of oncology practices. Key duties include identifying clinical trial candidates, performing remote chart reviews, and collaborating with cross-functional teams to optimize the Genospace software platform.
Oversee client treatment from assessment through delivery, including developing BIPs and treatment plans. Provide clinical supervision to Behavior Technicians and collaborate with families and schools to implement best practice interventions.
Adjunct Assistant Professor, Physician Assistant
West Coast University, Inc.
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Full Time
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3 Weeks Ago
West Coast University, Inc.
The role involves providing professional leadership and instruction to Physician Assistant students through various teaching methodologies. Responsibilities include developing class materials, mentoring students, and contributing to the evaluation and revision of the overall curriculum.
Lead evaluation services for children suspected of having autism by conducting standardized assessments. Interpret test results to write comprehensive diagnostic evaluation reports.
Lead evaluation services for children suspected of having autism by conducting standardized assessments. Interpret test results to write comprehensive diagnostic evaluation reports.
Lead complex clinical trials and New Drug Applications by developing Statistical Analysis Plans and providing statistical oversight. Manage project timelines, resource planning, and provide mentoring to junior staff while serving as a Subject Matter Expert.
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Regional Recruiting Director - Ohio, Western PA, and West Virginia
Ameriprise Financial Services, LLC
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Full Time
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3 Weeks Ago
Ameriprise Financial Services, LLC
The role focuses on recruiting quality new advisors into the firm by building relationships with advisors at competing firms across Ohio, Western PA, and West Virginia. Key duties include managing the recruiting pipeline, communicating the company value proposition, and partnering with field leaders to achieve business strategies.
California Workers Compensation - Telephonic Nurse Case Manager (Remote)
Berkley
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Full Time
·
3 Weeks Ago
Berkley
Assess, plan, and coordinate medical care and return-to-work outcomes for injured workers. Communicate with employers, adjusters, and physicians to ensure cost-effective, quality care and timely case closure.
Provide remote behavioral health care, including individual and group therapy, to inpatient and outpatient populations within the UHS network. Responsibilities include conducting assessments, creating treatment plans, and collaborating with multidisciplinary care teams.
Perform psychiatric assessments, follow-ups, and medication management specifically for adolescent patients via telemedicine. Handle refill requests and emergency patient phone calls as needed.
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