Manage a team of 6+ to oversee day-to-day clinical operations for mental health evaluations and leave services. Develop standard operating procedures and analyze data to improve efficiency, quality, and program decision-making.
Work From Home Jobs (229,414)
The role involves interpreting clinical criteria to review and approve prior authorization requests for pharmacy and medical claims. It also requires coordinating with pharmacists and providers while handling inbound and outbound inquiries.
Lead the end-to-end execution of high-priority Medicaid proposal efforts, ensuring compliant and compelling responses. Coordinate between capture, solution design, and executive leadership to align strategy and manage risks throughout the RFX lifecycle.
The Manager supports corporate strategy, analytics, and insights by developing deliverables for the CEO and Board of Directors. They lead strategy projects, conduct market research, and mentor analysts to identify strategic opportunities.
Lead a team in delivering healthcare data and medical economics analyses to improve costs and operational performance. Partner with cross-functional teams to translate complex data insights into strategic business recommendations.
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Coordinate long-term services and supports for Medicaid participants through face-to-face assessments and participant-centered planning. Manage the delivery of physical, behavioral, and social services while ensuring participants are informed of their rights and options.
The role involves interpreting clinical criteria to review and approve prior authorization requests for pharmacy and medical claims. It also requires coordinating with pharmacists and providers while handling inbound and outbound inquiries.
The analyst conducts research and analysis of regulatory edits to identify and validate overpayment concepts for Medicaid and Medicare lines of business. They are responsible for implementing cost avoidance processes and ensuring payment rules are updated based on federal and state statutes.
Medical Director Utilization Management
Amerihealth Caritas
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Full Time
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3 Weeks Ago
Amerihealth Caritas
Lead the operational areas of the Utilization Management program, ensuring patient care decisions are medically appropriate using national and local criteria. Collaborate with multidisciplinary teams to develop medical policies and analyze utilization trends to improve clinical effectiveness.
Lead the end-to-end execution of Medicaid RFX responses, translating capture strategy into compliant and high-quality proposals. Act as the central integrator across solution design, writing, and production to ensure on-time, error-free submissions.
Process service forms and distribute literature to members while managing provider directories and welcome kits. Research and correct mailing addresses using USPS tools and maintain department production statistics.
Lead the operational areas of the Utilization Management program, ensuring patient care decisions are medically appropriate using national and local criteria. Collaborate with multidisciplinary teams to develop medical policies and analyze utilization trends to improve clinical effectiveness.
The role involves managing customer satisfaction surveys and monitoring KPIs via Power BI and Qualtrics to optimize customer journeys. Additionally, the candidate will support the transition to new CRM/ERP systems and analyze customer feedback to drive service improvements.
Manage and resolve a high volume of technical tickets using Jira and Confluence while adhering to established SLAs. Perform deep diagnostics of incidents, analyze logs, and collaborate with Product and QA teams to report bugs and improve processes.
Lead a squad of 8 to 10 team members and manage the product backlog. Provide mentorship to new team members to ensure project success.
Regulatory Affairs Consultant - CMC vax/bio (home or office based)
Parexel
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Full Time
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3 Weeks Ago
Parexel
Develop and execute submission strategies for post-approval CMC activities, including variations and renewals for vaccines and biologicals. Coordinate with cross-functional departments to review study reports and ensure compliance with global regulatory requirements.
Senior Regulatory Affairs Associate - CMC biologics/vaccines (home or office based)
Parexel
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Full Time
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3 Weeks Ago
Parexel
Develop and execute submission strategies for post-approval CMC activities, including variations and renewals for biologicals and vaccines. Coordinate with cross-functional departments to review study reports and ensure compliance with global regulatory requirements.
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Knowledge Management Lawyer - Construction & Engineering - part time and any location
Freeths
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Full Time
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3 Weeks Ago
Freeths
Manage and update the Construction & Engineering precedent bank, focusing on standard form contracts like JCT and NEC. Provide legal updates, design training for lawyers, and integrate AI tools into the team's daily workflows.
Lead the enterprise strategy, governance, and continuous improvement of maintenance systems and CMMS across the manufacturing network. Establish standardized maintenance processes, OEE reporting frameworks, and reliability initiatives to improve equipment uptime and operational efficiency.
Responsible for the timely editing, submission, and follow-up of Medicaid and other payer claims to ensure accurate reimbursement. Provides guidance to team members and resolves complex billing issues in the absence of management.
Senior Engineer, Process - Purified Water Systems
Voyant Beauty
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Full Time
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3 Weeks Ago
Voyant Beauty
Acts as the corporate technical authority for purified water systems across the manufacturing network to ensure reliability and regulatory compliance. Leads system design, optimization, and root cause investigations while establishing enterprise-wide performance metrics.
Provide strategic oversight and governance of facility infrastructure, utilities, and regulatory compliance across the manufacturing network. Develop long-term capital improvement roadmaps and lead energy optimization initiatives to ensure operational reliability and sustainability.
Remote Sales Manager (m/w/d) | 2.500 € Fixgehalt + unbegrenzte Provision
smartkündigen OHG
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Full Time
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3 Weeks Ago
smartkündigen OHG
The role involves managing and expanding existing customer relationships and processing incoming inquiries. The manager is responsible for closing contracts and performing upselling to ensure sustainable customer growth.
The role involves identifying and establishing new strategic customer relationships while developing existing accounts within the wholesaler segment. Key tasks include executing customer plans, negotiating contracts, and analyzing market data to drive profitable growth.
The role involves conducting regular quality monitoring of support agents and providing structured feedback to drive growth. Additionally, the specialist will develop training materials, conduct knowledge assessments, and analyze customer feedback to optimize service processes.
Vertriebsmitarbeiter (w/m/d) - deutschlandweit im Home-Office
audibene
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Full Time
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3 Weeks Ago
audibene
Manage the entire sales process from initial warm contact and individual consultation to the final sale. Coordinate with partner acousticians to ensure customer success and track personal performance via KPIs and CRM systems.
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Partner with executives to design short- and long-term business plans and go-to-market strategies for international markets. Collaborate across functions to drive strategic initiatives and establish KPIs to measure success and operational efficiency.
Conduct administrative hearings to decide whether to sustain or dismiss civil summonses filed by NYC agencies. Review evidence, assess legal arguments, and issue written decisions in a timely manner.
Lead and scale core supply operations functions including onboarding, loading, and connectivity for a team of approximately 15 people. Establish operational structures, SOPs, and reporting frameworks to ensure efficient partner onboarding and high data quality.
Design, build, and maintain cloud-native AI platforms and infrastructure. Develop and optimize AI agent solutions using modern agentic frameworks and AI runtime technologies.
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