The Physician Reviewer manages Utilization Management cases and coordinates care for patients across assigned territories. They participate in process and quality improvement for Delegated Utilization Management and advise other physician reviewers.
Remote Healthcare Jobs (12,051)
Job category = Healthcare
The Physician Reviewer manages Utilization Management cases and coordinates care for patients across assigned territories. The role involves attending health plan calls and participating in process and quality improvement for Delegated Utilization Management.
Provide virtual mental health therapy to children, teens, and young adults focusing on low-acuity cases. Manage clinical intakes and treatment planning using a digital dashboard and AI-assisted tools.
Director, New Product Go -To - Market - Healthcare Technology - Solventum
SOLVENTUM
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Full Time
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Yesterday
SOLVENTUM
Drive sales growth and contract targets for new healthcare technology product launches by developing innovative sales strategies. Collaborate with product teams and C-level decision makers to align solution roadmaps with measurable business value.
Associate Clinical Specialist, Cardiac Rhythm Management - Eugene, OR
Abbott
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Full Time
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Yesterday
Abbott
The role provides comprehensive engineering, sales, and technical support for Cardiac Rhythm Management products to healthcare professionals and patients. Key duties include acting as a clinical interface, facilitating training sessions, and supporting CRM Sales Representatives.
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Manages the care of patients in the Care Transitions program by performing assessments and developing patient-centered care plans. Coordinates follow-up care, provides clinical triage, and ensures effective discharge planning through collaboration with community resources.
Physician Advisor (UM) - Part Time 1099 Must have CA License
Alignment Health
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Full Time
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Yesterday
Alignment Health
The Physician Advisor performs clinical reviews for medical necessity and treatment appropriateness in compliance with CMS and Milliman guidelines. They collaborate with interdisciplinary teams to optimize institutional and outpatient services while overseeing quality outcomes and chronic disease management.
The role involves assessing and coordinating healthcare services for members by applying clinical criteria and guidelines to render coverage determinations. The consultant collaborates with providers to facilitate treatment and identifies opportunities to improve the quality and effectiveness of benefit utilization.
Internal Medicine Health & Science System Specialist - Harrisburg, PA
Pfizer
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Full Time
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Yesterday
Pfizer
The role is responsible for driving sales performance of the Primary Care portfolio through strategic customer engagement and compliant promotional messaging. It involves partnering across the healthcare ecosystem to reduce access barriers and support coordinated care pathways.
Conduct holistic health assessments and develop member-centric case management plans to improve health outcomes. Coordinate care among healthcare providers and use motivational interviewing to remove barriers to well-being.
Engage members with mental health or substance use disorders to conduct holistic health assessments and develop member-centric care plans. Coordinate with healthcare providers and use motivational interviewing to remove barriers to emotional well-being and health outcomes.
Nurse Practitioner – Addiction Medicine (Telehealth)
Boulder Care
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Full Time
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Yesterday
Boulder Care
Independently initiate and manage buprenorphine treatment for patients with opioid use disorder in a remote outpatient setting. Deliver evidence-based, compassionate care aligned with harm reduction principles within a multidisciplinary team.
Nurse Practitioner – Addiction Medicine (Telehealth)
Boulder Care
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Full Time
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Yesterday
Boulder Care
Independently initiate and manage buprenorphine treatment for patients with opioid use disorder in a remote outpatient setting. Deliver evidence-based care using harm reduction principles within a multidisciplinary team model.
Corporate Health Insurance Consultant - Commercial Line
LEGACY PROTECTION GROUP LLC
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Full Time
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Yesterday
LEGACY PROTECTION GROUP LLC
The consultant is responsible for prospecting and developing new employer relationships to assess and implement tailored employee benefit programs. They will coordinate with insurance carriers to provide competitive quotes and manage the full client lifecycle from enrollment to renewal.
Clinical Review Nurse
Ternium Revenue Cycle Management
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Full Time
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Yesterday
Ternium Revenue Cycle Management
Analyze denied insurance claims and medical records to determine if appeals are justified using national clinical criteria. Draft persuasive, medically sound appeal letters to help hospitals recover lost revenue.
Medical Science Liaison - Cell Therapy & Transplant
CareDx, Inc.
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Full Time
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Yesterday
CareDx, Inc.
The MSL will support the initiation and management of clinical studies for the AlloHeme test and engage with Key Opinion Leaders in bone marrow and cell therapy. They will also educate stakeholders on clinical value and support the launch of molecular testing products.
The role involves evaluating service requests for medical necessity using evidence-based tools and coordinating complex cases to optimize clinical outcomes. Additionally, the nurse manages discharge planning and provides administrative support for medical documentation and claim appeals.
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The Collection Specialist manages medical accounts receivable and denied claims to ensure timely and accurate payments. Key duties include researching outstanding balances, negotiating patient payment plans, and identifying denial trends to improve billing efficiency.
The Registered Nurse Telehealth provides remote clinical support and guidance to onsite staff using virtual technology. Responsibilities include assessing patient needs, supporting individualized treatment plans, and documenting nursing encounters.
The Senior Clinical Data Specialist categorizes, codes, and interprets patient medical records for registry and measure data repositories. They are responsible for maintaining high data accuracy and contributing to team best practices and abstraction guidelines.
The Senior Clinical Data Specialist categorizes, codes, and interprets patient medical records for submission to specified registries and data repositories. They also contribute to the development of abstraction guidelines and identify process improvement opportunities to streamline data tasks.
The specialist is responsible for categorizing, coding, and summarizing patient medical records for registry submission with high accuracy. They also contribute to data dictionaries and abstraction guidelines while ensuring compliance with regulatory requirements.
Oversee and manage clinical trial activities to ensure adherence to protocols, regulatory requirements, and industry standards. This includes conducting site visits, collaborating with cross-functional teams, and providing training to site staff.
Conduct virtual consultations to diagnose and treat complex cardiovascular conditions for elderly patients. Develop personalized treatment plans and collaborate with healthcare professionals to provide comprehensive outpatient care.
Provide telephonic clinical assessments, nursing triage, and patient education to diverse populations across the health continuum. Coordinate with team members to direct patients to appropriate care levels and perform outbound follow-up calls.
Clinical Specialist II, Cardiac Rhythm Management - Long Island, NY
Abbott
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Full Time
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Yesterday
Abbott
The role provides engineering, sales, and technical support for Cardiac Rhythm Management products to healthcare professionals and patients. Key duties include acting as a clinical interface, leading training sessions, and supporting CRM Sales Representatives.
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Clinical Supervisor II (BCBA)
Center for Autism and Related Disorders
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Full Time
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Yesterday
Center for Autism and Related Disorders
The Clinical Supervisor II manages all clinical aspects of patient treatment, including developing individualized treatment plans and analyzing challenging behaviors. They are responsible for supervising and coaching behavioral technicians while collaborating with caregivers and payers to ensure optimal patient outcomes.
Clinical Supervisor II (BCBA)
Center for Autism and Related Disorders
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Full Time
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Yesterday
Center for Autism and Related Disorders
The Clinical Supervisor II manages all clinical aspects of treatment for patients, including assessment, treatment plan development, and data analysis. They are responsible for overseeing behavioral technicians and collaborating with caregivers to ensure optimal patient outcomes.
The extern will learn various processes and functions within the Managed Care industry while contributing to business support projects. Responsibilities include researching legal and regulatory topics and attending professional development presentations.
The Physician Reviewer manages Utilization Management cases and coordinates care for patients across assigned territories. They also participate in process and quality improvement for Delegated Utilization Management and advise other physician reviewers.
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