Bilingual Customer Service Representative (Federal)
Provide support and service to providers and members, ensuring the highest level of customer service. Effectively problem solve and contribute positively to a team environment.
Remote Medical Jobs (35,434)
Director Advanced Analytics and AI - Shockwave Medical
The Director, Advanced Analytics & AI is responsible for spearheading the strategy, development, and application of advanced analytics, machine learning, and artificial intelligence to optimize commercial operations. This role will oversee the deployment of advanced analytics driven tools, predictive analytics, and data science methodologies to drive revenue growth and enhance business decision-making.
Client Experience Leader, CRMG - Founder Shield
The Client Experience Leader is responsible for leading and mentoring a team to ensure world-class service delivery to clients. They will also manage client segmentation strategies and maintain high client retention rates.
Provider Engagement Specialist – San Diego County (Field Remote)
The Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance and enhance provider satisfaction. This role partners with providers on strategies to increase patient retention and growth while driving performance across key quality and utilization metrics.
Sr. Director, Enterprise CGT, Commercial Enablement
The Sr. Director is responsible for aligning and integrating initiatives to accelerate CGT commercial growth across BLS. This role involves collaborating across a matrixed organization to enhance CGT capabilities and foster partnerships for business expansion.
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Medical Director - Spine
The Medical Director (Spine) will expand Aetna's medical management programs to address member needs across the continuum of care and support the Medical Management staff. They will lead utilization review and quality assurance, providing clinical expertise and business direction in support of medical management programs.
Medical Director - Medicaid Northeast 12 applicants
The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review.
Care Management Associate OhioRISE, must live in OHIO
The Care Management Associate manages enrollment for the Children’s Specialty program and supports comprehensive coordination of medical services. This role involves developing wellness plans, engaging community resources, and ensuring effective utilization of healthcare services.
Medical Director - Kentucky Medicaid
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and pre-certification as well as concurrent review.
Medical Director - Heartland
The Medical Director will oversee medical policy implementation and participate in the development and evaluation of clinical programs. They will focus on utilization review and quality assurance, ensuring effective execution of medical services programs.
Medical Director - Medicaid (IL) 12 applicants
The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review.
Medical Director - Medicare Appeals
The Medical Director will direct daily work on Part C appeals and provide support to appeal nurses. They will also monitor IRE and collaborate with Medicare Quality and Compliance.
Medical Director - West Virginia Medicaid
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and pre-certification as well as concurrent review.
Medical Director-Medicaid (ABH TX) 13 applicants
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and concurrent review.
Medical Director-Medicaid (ABH TX)
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as concurrent review.
Sr. Software Dev Engineer - IBMi
Lead the design and development of solutions for complex technical projects while acting as a subject matter expert. Collaborate with various stakeholders to solve technical problems and ensure timely progress of system design and development tasks.
Case Manager – Registered Nurse – Field – Southwest Michigan + Bonus Available 35 applicants
The Case Manager is responsible for assessing, planning, implementing, and coordinating case management activities to evaluate the medical needs of members. They develop proactive care plans and collaborate with various stakeholders to enhance member wellness and address health and social challenges.
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SFE Training Manager - Chronic and Post Acute Wound Care
The SFE Training Manager will design and develop sales enablement training for the Advanced Wound Care US Business Unit, focusing on onboarding, advanced account selling skills, and new product launches. This role involves partnering with various stakeholders to enhance field effectiveness and ensure compliance with regulatory guidelines.
Staff Software Development Engineer
The Staff Software Development Engineer will design, build, and deploy infrastructure capabilities for database technologies in various cloud environments. They will collaborate with multiple teams to create automation and improve customer experiences.
Manager - Strategic Financial Planning & Investments 12 applicants
The Manager will support key financial initiatives through financial modeling, capital planning, and business case development. This role involves collaboration across teams to drive data-informed decisions and operational efficiency.
Case Manager Registered Nurse- San Antonio, TX 50 applicants
The Case Manager RN is responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs. This role involves developing proactive strategies to enhance members' overall wellness and facilitate smooth transitions to Aetna programs and plans.
Care Management Associate - OhioRISE - Must live in Ohio 19 applicants
The Care Management Associate will interface with various groups providing care coordination services for eligible children and young adults receiving Medicaid services in Ohio. They will handle administrative tasks, including managing inbound care management inquiries and processing referrals.
Clinical Specialist - San Diego, CA
The Clinical Specialist provides comprehensive engineering, sales, educational, and technical support for Cardiac Rhythm Management products. This role acts as a clinical interface between the medical community and the business, responding to inquiries and facilitating training sessions for healthcare professionals.
Senior Business Analyst - SAS Coder 14 applicants
The Senior Business Analyst - SAS Coder will perform analysis, development, and evaluation of complex reports related to Medicaid and FoodShare programs. This role involves determining report specifications, meeting with stakeholders, and ensuring compliance with federal and state regulations.
Lead Mobile Diesel Mechanic
The Lead Mobile Diesel Technician will perform licensed DOT inspections, preventative maintenance inspections, and advanced repairs on various types of vehicles in a mobile environment. This role also involves mentoring other technicians and managing customer interactions effectively.
Staff Software Engineer, Foundational Model Serving
Design and implement core systems and APIs for Databricks Foundation Model Serving, ensuring scalability and reliability. Collaborate with product and engineering leadership to define the technical roadmap and optimize performance for GPU serving workloads.
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Clinical Trial Liaison 367 applicants
The Clinical Trial Liaison supports clinical trials by providing scientific and clinical support to investigators and site staff. They also function as recruitment specialists to develop and optimize strategies for successful patient enrollment.
Part-Time Weekend Medical Director (Remote) 28 applicants
The Medical Director ensures that utilization management responsibilities are performed according to clinical standards by reviewing escalated cases and determining medical necessity. They also participate in multidisciplinary teams for case and disease management, advising on high-risk cases and managing special projects.
Product Launch Program Manager - Cards Category
The Product Launch Program Manager oversees new product introductions and sustaining activities for existing products in the Cards category. This role involves coordinating cross-functional teams to ensure successful product launches and ongoing product improvements.
RN Case Manager-ONCOLOGY (REMOTE) 162 applicants
The RN Case Manager is responsible for assessing patients' clinical needs and coordinating care to ensure appropriate levels of care. This role includes monitoring services, advocating for members, and collaborating with multidisciplinary teams.
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