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.
Remote Healthcare Jobs (12,051)
Job category = Healthcare
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.
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 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.
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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3 Days Ago
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.
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Lead the Customer Support team to deliver a best-in-class experience across all regions and channels. Manage day-to-day operations, monitor KPIs, and collaborate with engineering and operations teams to resolve client issues.
Serve as a trusted advisor to GPO members by optimizing pharmacy strategies through formulary scenario analyses and rebate optimization. Collaborate with cross-functional teams to deliver actionable recommendations based on clinical evidence and financial impact analyses.
Optimize clinical workflows and manage day-to-day virtual clinic operations to ensure a high-quality patient experience. Responsibilities include monitoring lab results, handling clinic communications, and coordinating with external vendors and pharmacy partners.
The Senior Clinical Data Manager will be embedded within a pharmaceutical client to drive innovation in patient treatment. They will manage clinical data processes and maintain cross-functional interfaces within a global pharmaceutical program.
Manage the pharmacy vendor portfolio and optimize cost models for compounded and branded medications. Oversee the end-to-end member shipment experience and ensure regulatory compliance across the pharmacy network.
Travelling Director of Clinical Services Specialists
Brookdale Senior Living Inc.
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Full Time
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3 Days Ago
Brookdale Senior Living Inc.
Oversee clinical services and apply guidelines to make departmental decisions and solve complex problems. Ensure high-quality clinical care and resident safety across various communities.
Personal Health Nurse - Remote
Conifer Health Solutions
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Full Time
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3 Days Ago
Conifer Health Solutions
The Personal Health Nurse performs holistic medical management by assessing members, developing individualized care plans, and coordinating services with physicians. They are responsible for empowering members to self-manage their health while ensuring cost-effective care delivery.
Cardiovascular Ultrasound PT Adjunct Faculty
Smith Chason College | WCUI School of Medical Imaging | Smith Chason School of Nursing
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Full Time
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3 Days Ago
Smith Chason College | WCUI School of Medical Imaging | Smith Chason School of Nursing
Provide high-quality instruction and guidance to students in cardiovascular ultrasound through lectures and practical lab demonstrations. Maintain academic records, update syllabi, and ensure the proper functioning of instructional equipment and lab environments.
Lead the clinical onboarding and success of hospital customers implementing InsightRX Nova and Apollo platforms. Provide pharmacokinetic expertise and training while collaborating with product and data science teams to improve clinical outcomes.
The VP of Clinical Recruitment leads the strategic acquisition and retention of top-tier cardiovascular physicians to expand the healthcare network. This includes managing the end-to-end recruitment pipeline, negotiating compensation packages, and ensuring regulatory compliance with healthcare laws.
The VP of Clinical Recruitment leads the strategic acquisition and retention of top-tier cardiovascular physicians to expand the healthcare network. This includes managing the end-to-end recruitment pipeline, negotiating compensation packages, and ensuring compliance with healthcare laws.
Provide mental health and psychiatric assessment, diagnosis, and treatment for patients in correctional facilities via telehealth. Collaborate with a multidisciplinary team under the clinical direction of a psychiatrist.
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ENGAGEMENT CENTER TRIAGE RN, FCP - PATIENT ENGAGEMENT CENTER
Froedtert
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Full Time
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3 Days Ago
Froedtert
Responsible for assessing, planning, and evaluating care for patients via telephone-based triage within the Patient Engagement Center. Duties include managing test results, coordinating care needs, and providing patient and family education.
The Caregiver Coach supports caregivers in integrating into eating disorder treatment by implementing care plans and building necessary coping skills. They are responsible for conducting individual and group sessions, managing patient engagement, and collaborating with a multidisciplinary care team.
Safety & Health Service Specialist
Zenith Insurance Company
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Full Time
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3 Days Ago
Zenith Insurance Company
The specialist conducts underwriting surveys and evaluates workplace safety exposures to reduce workers' compensation loss potential for large accounts. They develop safety service plans, provide consultation, and influence policyholders to implement risk improvement recommendations.
The role involves coordinating and monitoring clinical trial activities, including maintaining study documentation and ensuring cost efficiency. It also requires building collaborative relationships with investigators and ensuring strict compliance with regulatory requirements and patient safety.
Oversee and manage clinical trial activities to ensure adherence to protocols, regulatory requirements, and industry standards. Lead monitoring tasks, conduct site visits, and collaborate with cross-functional teams for accurate data collection.
Oversee and manage clinical trial activities to ensure adherence to protocols, regulatory requirements, and industry standards. Lead monitoring tasks, conduct site visits, and collaborate with cross-functional teams for accurate data collection.
The role involves conducting site qualification, initiation, monitoring, and close-out visits for clinical trials. It also requires ensuring protocol compliance, data integrity, and collaborating with investigators to maintain high-quality clinical data.
Clinical Manager, Performance Improvement
Nordic Healthcare Group (NHG)
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Full Time
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3 Days Ago
Nordic Healthcare Group (NHG)
Lead strategic performance improvement initiatives for healthcare clients by designing analytical models and mapping workflows. Manage project artifacts and mentor team members to deliver high-quality clinical and operational solutions.
Senior Clinical Research Associate - Psychiatry - West Coast (Remote)
Worldwide Clinical Trials
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Full Time
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3 Days Ago
Worldwide Clinical Trials
Manage research activities at clinical sites, including site identification, start-up, and close-down. Conduct study initiation visits and ensure compliance with informed consent and safety reporting requirements.
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Provides engineering, sales, and technical support for Electrophysiology products to healthcare professionals and patients. Acts as a clinical interface between the medical community and the business to facilitate training and procedural case coverage.
Supports care management activities by performing member outreach and coordinating services with healthcare providers to ensure continuity of care. Documents care plans and provides education on available benefits and resources to members, specifically within the foster care population.
Coordinates care activities and performs outreach to behavioral health foster care members to ensure continuity of care and service plan adherence. Acts as a liaison between care managers, providers, and members to facilitate healthcare delivery and resolve complex inquiries.
Medical Director, Utilization Management (Commercial & MA)
HJ Staffing
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Full Time
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3 Days Ago
HJ Staffing
Lead the clinical integrity of utilization management functions focusing on inpatient and post-acute care reviews for Commercial and Medicare Advantage members. Conduct medical necessity determinations and engage in peer-to-peer consultations to ensure optimal clinical outcomes and regulatory compliance.
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