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Clinical Services Director remote jobs

- 783 jobs
  • Medical Director

    Ascendo Resources 4.3company rating

    Remote job

    Medical Director - Medicare Programs Remote | Approx. $300,000 base + significant bonus potential About the Opportunity: A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale. Key Responsibilities: Clinical Leadership: Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties. Policy Development: Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance. Program Integrity: Identify trends in billing or compliance issues and work with investigative teams to address improper claims. Medical Review & Appeals: Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary. Provider Education: Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices. Travel is minimal (approximately 3-4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences. Required Qualifications: MD or DO from an accredited institution. Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required). Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years). At least three years of experience as an attending physician. Prior experience within the Medicare, health insurance, or utilization review environment. Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures. Excellent communication and collaboration skills across technical, regulatory, and clinical teams. Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms). Preferred Qualifications: Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease. Five or more years of clinical practice experience. Prior experience as a Medical Director in a Medicare or commercial payer organization. Familiarity with HCPCS, CPT, and ICD-10 coding standards. Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS). Experience performing systematic literature reviews or using GRADE methodology. Compensation & Benefits: Base salary: Approximately $300,000, flexible depending on experience. Bonus structure: Significant performance-based bonuses. Benefits: Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support. Schedule: Full-time, remote position with flexible hours. Why Join: This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.
    $300k yearly 4d ago
  • Prior Authorization Medical Director Physician- Los Angeles, CA Area - Work From Home

    Curative 4.0company rating

    Remote job

    Prior Authorization Medical Director Physician Opportunity in the Los Angeles Area Please consider this unique opportunity to join a well-established and respected group of innovators in value-based care. This group of thought-leaders are in search of physician leaders to work alongside them to move the organization forward. Requirements MD/DO degree required Remote position, but candidate must live in the greater L.A. area for onsite meetings. Minimum of five years of prior clinical experience required, with at least two years of managed-care or health-plan experience preferred About the Opportunity Understand, promote, and manage the principles of medical management to facilitate the right care for patients at the right time and in the right setting. Review prior authorization requests for medical necessity using appropriate clinical guidelines. Identify high-risk patients and help coordinate care with the Employer's high-risk team. Participate in meetings to review, develop, and continually improve internal quality improvement and peer review processes and programs. Perform prior authorization functions for various Employer campuses, should the need arise in cross coverage, secondary/tertiary review, or medical director decision-making. Perform retroactive claims review for outpatient and inpatient care, as needed. Compensation and Benefits Competitive salary and aggressive incentives Comprehensive benefits including medical, dental, vision, and 401k Sign on bonus Ample paid time off About the Area Live in the entertainment capital of he world and enjoy dynamic mix of amenities that include outdoor adventures, fine dining, theme parks, the arts, world-class sports teams, and access to a major international airport Unmatched cultural amenities in one of the most diverse areas of the world Excellent public and private schooling options as highly respected colleges and universities World-class beaches and mountain resorts are within a short drive Enjoy a warm climate with over 300 sunny days a year
    $174k-266k yearly est. 5d ago
  • Medical Director (remote)

    Viewfi

    Remote job

    Reports Jointly To: Chief Executive Officer and Chief Medical Officer Clinical Specialty: MD, Board Certified in Sports Medicine (primary board specialty flexible) ViewFi is a nationwide virtual musculoskeletal (MSK) practice bringing high-quality orthopedic, sports-medicine, and physical-therapy care directly to patients in both traditional and non-traditional markets. We serve a diverse set of partners including personal injury/med-legal groups, self-insured employers, risk-based payers, and digital health collaborators in the sports and fitness markets through technology enabled, evidence-based clinical care. We are redefining what excellent MSK care looks like in a virtual environment. Position Summary The Medical Director will serve as the clinical leader of ViewFi's physician team and a core partner to our physical therapy, product, operations, and business teams. This role requires a practicing, board-certified Sports Medicine physician who can balance patient care with 30-40% administrative/leadership responsibilities. The Medical Director will ensure clinical excellence, maintain high-quality and consistent clinical pathways, represent ViewFi as the medical voice of the organization, and advance the science and evidence behind virtual MSK care. Key Responsibilities Clinical Leadership & Oversight Lead, oversee, and support the national team of physicians delivering virtual MSK care. Maintain and update clinical pathways, treatment standards, and practice guidelines across all ViewFi service lines. Partner closely with the Physical Therapy leadership team to ensure integrated, cohesive care between MDs and PTs. Ensure consistent, high-quality clinical documentation, coding accuracy, and compliance across markets. Oversee peer review, quality assurance activities, and clinical performance metrics. Participate in recruitment, onboarding, and ongoing development of new clinicians. Patient Care (70-80%) Actively see patients in a virtual setting, providing MSK consults and follow-ups. Model best-in-class virtual care workflows and contribute to continuous improvement of the patient experience. Support escalated or complex cases requiring senior clinical judgment. Strategic & Administrative Leadership (20-30%) Serve as the medical voice of ViewFi at conferences, webinars, panels, and partner meetings. Collaborate with executive leadership on product development, new service lines, geographic expansion and clinical innovation initiatives. Guide medical input for payers, partners, self-insured employers, and med-legal groups. Participate in strategic planning related to national expansion, licensure strategy, and resource allocation. Work cross-functionally with operations and technology teams to enhance clinical workflows. Provide medical insight and feedback on ViewFi's technology roadmap, including clinical decision support, AI integration, and general telehealth tools. Research, Publishing & Thought Leadership Lead or collaborate on clinical research demonstrating the efficacy of virtual MSK care, including both MSK MD consults and virtual PT. Publish and present outcomes, case series, and efficacy studies at relevant medical and industry conferences. Help build ViewFi's reputation as the leader in evidence-based virtual MSK care. Quality, Compliance & Risk Management Ensure the practice meets state and federal clinical guidelines, telehealth regulations, and licensure requirements. Maintain oversight of clinical incident review processes, risk-mitigation protocols, and outcome tracking. Drive continuous improvement in clinical quality, patient safety, and service reliability. Qualifications MD with Board Certification in Sports Medicine (primary board: FM, IM, EM, PM&R, etc. is flexible). Multi-state licensure required; willingness to pursue additional licensure required. Minimum 10 years of clinical experience; virtual care experience strongly preferred. Demonstrated leadership experience in a clinical or medical director role. Strong collaboration skills with PTs, operational teams, and cross-functional partners. Excellent communication and presentation skills; comfortable representing ViewFi publicly. Passion for virtual care, musculoskeletal medicine, and innovative delivery models. What We Offer Opportunity to lead a national MSK practice at the forefront of technology enabled virtual healthcare Collaborative environment with clinical and operational teams aligned around quality care and aggressive growth Competitive compensation with protected administrative time Support for conference travel, research, publishing, and clinical innovation Commitment to clinical excellence, patient outcomes, and provider support
    $174k-281k yearly est. 3d ago
  • Remote Medical and Health Services Managers - AI Trainer ($80-$110 per hour)

    Mercor

    Remote job

    ## **About the Role** Mercor is seeking experienced **medical and health services managers** to support a leading AI lab in advancing research and infrastructure for next-generation machine learning systems. This engagement focuses on diagnosing and solving real issues in your domain. It's an opportunity to contribute your expertise to cutting-edge AI research while working independently and remotely on your own schedule. ## **Key Responsibilities** - You'll be asked to create deliverables regarding common requests regarding your professional domain - You'll be asked to review peer developed deliverables to improve AI research ## **Ideal Qualifications** - 4+ years professional experience in your respective domain - Excellent written communication with strong grammar and spelling skills ## **More About the Opportunity** - Fully remote and asynchronous - complete work on your own schedule - Expected workload: 30 hours per week, with flexibility to scale up to 40 hours - Project start date: immediately, lasting for around 3-4 weeks ## **Compensation & Contract Terms** - Independent contractor engagement through Mercor - Hourly compensation, paid weekly via Stripe Connect - Payments based on services rendered; contractors maintain full control over their work schedule and methods . **About Mercor** - Mercor is a talent marketplace that connects top experts with leading AI labs and research organizations - Our investors include Benchmark, General Catalyst, Adam D'Angelo, Larry Summers, and Jack Dorsey - Thousands of professionals across domains like engineering, research, law, and creative services have partnered with Mercor on frontier AI projects We consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request. ## **Earn $250 by referring** Share the referral link below, and earn $250 for each successful referral through this unique link. There's no limit on how many people you can refer. Restrictions may apply. [Learn
    $70k-104k yearly est. 53d ago
  • Physician / Medical Director / Nevada / Permanent / Medical Director Job

    Spectrum Healthcare Resources 4.1company rating

    Remote job

    Spectrum Healthcare Resources is excited to offer a potential career opportunity for a Behavioral Health Medical Director supporting the TriCare/Department of Defense and Community Care Network/Department of Veterans Affairs. This remote-based civilian position is an outstanding chance to make a meaningful contribution to the healthcare of veterans and military beneficiaries while benefiting from work-life flexibility, professional collaboration, and impactful leadership. Join us in leading high-quality care initiatives for those who have served our country, with a focus on system-wide clinical improvement, peer collaboration, and mission-driven support! Requirements: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited medical school. Active, unrestricted license to practice medicine in the United States. Board certification or board eligibility through a recognized specialty board. U.S. Citizenship. Favorable background investigation through the Department of Defense (DoD). Minimum of 5 years of medical practice experience. 3+ years of experience in managed care environments.
    $188k-247k yearly est. 18d ago
  • Clinical Program Manager RN * Hybrid*

    Providence Health and Services 4.2company rating

    Remote job

    Clinical Program Manager RN Hybrid. Candidates residing in the areas of Portland, OR, Spokane, WA or Lubbock, TX are encouraged to apply. In collaboration with the Division Director, the Clinical Practice Manager RN supports nursing practice, quality initiatives, and clinical improvement efforts across the division. This role is responsible for leading teams in developing and implementing evidence-based nursing and clinical practices, utilizing established standards, research findings, and quality improvement principles. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Strategic And Management Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Bachelor's Degree: Nursing Master's Degree: Nursing (Practice or Education) 5 years - Nursing experience in an acute care setting. 3 years - Clinical practice development, quality, or education experience. active RN License for WA, OR or TX Preferred Qualifications: Ph.D.: Nursing or DNP (Doctor of Nursing Practice) Salary Range by Location: Oregon: Portland Service Area: Min: $59.39, Max: $93.75 Texas: Min: $45.30, Max: $71.51 Washington: Eastern: Min: $52.85, Max: $83.42 Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 403508 Company: Providence Jobs Job Category: Clinical Administration Job Function: Clinical Support Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4007 SS CNTRL DIV EDU ADMIN Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: Hybrid Pay Range: $see posting - $see posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. PandoLogic. Category:Healthcare, Keywords:Healthcare Program Manager, Location:New Deal, TX-79350
    $46k-77k yearly est. 5d ago
  • Director, Clinical Operations

    Alma International 4.4company rating

    Remote job

    Alma is on a mission to simplify access to high-quality, affordable mental health care. We do this by making it easy and financially rewarding for therapists to accept insurance and offer in-network care. When a provider joins Alma, they gain access to a suite of tools that not only help them better run their business, but also grow it sustainably and develop as a provider. Alma is available in all 50 states, with over 20,000 therapists in our growing network. Anyone looking for a therapist can browse Alma's free directory. Alma has raised $220.5M in funding from Insight Partners, Optum Ventures, Tusk Venture Partners, Primary Venture Partners, First Round Capital, Sound Ventures, BoxGroup, Cigna Ventures, and Rainfall Ventures. Alma was also named one of Inc's Best Workplaces in 2022 and 2023. Website Job Board Values Candidate Interview Guide --- Director of Clinical Operations The Director of Clinical Operations is a strategic and operational leader responsible for ensuring scalable and compliant clinical operations. Working closely with the Chief Operations Officer, you will align operational strategy with organizational goals to maintain excellence in workflow efficiency, compliance, and provider support. This role oversees the day-to-day operations of the Clinical Operations team and serves as an operational subject matter expert in the design and implementation of systems and technologies that enhance efficiency, compliance, and provider performance across the Alma network. Key Responsibilities Operational Compliance & Oversight Lead the design and execution of internal auditing systems that support continuous improvement in operational quality and compliance. Develop and track operational compliance KPIs, using data to drive strategy and operational enhancements. Ensure operational frameworks align with federal and state regulations, industry best practices, and Alma's standards. Monitor audits, risk protocols, and compliance efforts to proactively identify risks and uphold the highest operational standards. Operational Execution & Program Management Serve as the operational lead for Alma's documentation review program, translating strategic vision into phased, actionable workflows. Develop and optimize scalable processes that ensure compliant operational workflows and documentation standards. Collaborate with the COO to integrate operational quality efforts into company-wide operational systems and performance metrics. Partner with cross-functional leaders to align operational strategy with product, technology, and operations initiatives. Use performance data and audit trends to inform quality initiatives and provide strategic updates to executive stakeholders. Leadership of the Alma Integrity Standards Program Direct the Integrity Standards team in monitoring provider adherence to administrative and membership standards, including conduct and fraud monitoring. Guide the development and execution of protocols to detect and address deviations from Alma's operational expectations. Review findings and recommendations from the team and ensure appropriate follow-up actions are taken. Work cross-functionally to implement corrective actions and long-term improvements. Provide coaching and professional development for team leaders, ensuring high team performance and engagement. Oversee resource planning and ensure effective internal and cross-functional communication. Strategic Alignment & Cross-Functional Collaboration Collaborate with senior leadership to ensure operational initiatives support broader strategic priorities, including growth, technology adoption, and provider engagement. Partner with Product and Marketing teams to align rollout milestones with provider experience and operational capacity. Provide operational expertise to initiatives focused on workflow innovation, efficiency, and request fulfillment (e.g., medical record requests). Qualifications 10+ years of progressive experience in operations management and leadership in a tech-forward environment, with significant operational and quality improvement responsibilities. Demonstrated success in leading data-driven operational quality and compliance programs at scale. Strong track record of integrating technology into operational workflows and documentation practices. Knowledge of healthcare regulations, compliance standards, and risk mitigation strategies. Exceptional leadership, communication, and change management skills. Ability to use operational metrics to inform strategy and drive accountability across multidisciplinary teams. Benefits: We're a remote-first company Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans 401K plan (ADP) Monthly therapy and wellness stipends Monthly co-working space membership stipend Monthly work-from-home stipend Financial wellness benefits through Northstar Pet discount program through United Pet Care Financial perks and rewards through BenefitHub EAP access through Aetna One-time home office stipend to set up your home office Comprehensive parental leave plans 12 paid holidays and 1 Alma Give Back Day Flexible PTO Salary Band: $170,000-$180,000 All Alma jobs are listed on our careers page. We do not use outside applications or automated text messaging in our recruiting process. We will not ask for any sensitive financial or identification information throughout the recruiting process. Any communication during the recruitment process, including interview requests or job offers, will come directly from a recruiting team member with a helloalma.com email address. Learn more about how Alma handles applicant data by reading Alma's Applicant Privacy Notice.
    $170k-180k yearly Auto-Apply 60d+ ago
  • Director Of Clinical Operations

    Virginpulse 4.1company rating

    Remote job

    Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities TEXT BODY - ( Advertising Summary ) What You'll Actually Do ESSENTIAL DUTIES and RESPONSIBILITIES: Responsible for the overall clinical aspects of the Care Management Team. · Supervise Utilization Review (UR), Chronic Disease Management (DM) and/or Case Management (CM) team personnel including participating in interviewing, hiring, and training employees; plan, assign, and direct work; appraise performance; rewarding and disciplining employees; addressing complaints and resolving problems. · Keep team informed of clinical updates, compliance related issues and policies. · Work with the VP of Care management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives. · Use appropriate judgment in upward communication regarding department or employee concerns. · Maintain and improve UR, DM, and CM teams operations by monitoring system performance; identify and resolve problems; audit and analyze staff performance; prepare and complete action plans; assist in managing system and process improvement and quality assurance programs as it relates to clinical management and plan language interpretation. · Oversee the negotiation and implementation of cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews as it relates to clinical aspects. · Ability to meet productivity, quality, and turnaround times daily. · Ability to pass external audits to include URAC and NCQA. · Maintain HIPPA compliance per company's policy and procedures. · Maintain confidentiality and minimum requirement rules. · Complete all required yearly training per company's expected period. · Ability to communicate with external sponsors and vendors and to communicate clearly about the programs that are offered by the company internally and externally. · Ability to create, teach and present information to internal and external audiences with varying backgrounds and cultures KEY COMPETENCIES: To work in the health industries and to work remotely, it has been demonstrated that those with computer skills work better in these remote job descriptions. UPON HIRE, must have: · Basic computer literacy · The ability to work on multiple screens, and proficient typing skills. · Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook Excellent verbal and written communication skills · Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as the ability to understand and interpret complex information from others. · Ability to work independently and utilize written resources to solve problems. After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: o Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet-there may be additional programs as it relates to job duties · Knowledge of medical claims and ICD-10, CPT, HCPCS coding · Excellent verbal and written communication skills for upward and downward conversations · Microsoft Office and other computer skills and ability to learn and help guide software development · Flexible and able to prioritize day-to-day position requirements · Strategic thinking with proven ability to communicate a vision and drive results · Proficient in analysis and interpretation of clinical data · Comfortable with multiple accountabilities and matrix management · Proven record of strong relationships and working with diverse teams · Demonstrated ability to work independently with excellent judgment · Strong interpersonal skills necessary to effectively communicate with medical personnel and members · Analytical and problem-solving skills necessary to identify and review pertinent information · The ability to incorporate analytical data into new or existing clinical programs to enhance quality of care · Ability to maintain an extremely elevated level of confidentiality · Able to successfully handle competing priorities · Experience in the Utilization Review Process which includes Prior-Authorization/Pre-Certification, Retro Reviews, Concurrent Reviews and Post Service Claims Review · Experience in disease management and know and understand disease progression · Knowledgeable of the Federal, State and ERISA regulations Qualifications What You Bring to Our Mission · Associate Degree of Nursing plus 3 years mgt. experience and/or Bachelor Degree of Nursing RN · Licensure in California required. · Master's degree of Nursing preferred · Certification in Case Management or Utilization Review a plus. · Minimum 5 years of Utilization Review, Case Management, Chronic Disease Management, and/or Hospital experience required. · Minimum 3 years of compliance related experience preferred. · Experience working in sales, with groups, Medicaid, Medicare, fully insured, HMO and Self Insured preferred · Managed Care management experience preferred in UR, CM, DM Physical and Mental Requirements: · Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. · Ability to maintain regular, punctual attendance. · Ability to sit for 6-8 hours. · Ability to travel throughout the United States and external countries. · Constant use of computer keyboard and mouse; repetitive use of both hands. · Occasional to frequent twisting of neck; occasional bending of neck and at waist. Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world? We're ready for you. No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you! Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $118,560-$137,280. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site. Application Deadline: Open until position is filled.
    $118.6k-137.3k yearly Auto-Apply 20h ago
  • Program Manager, Clinical Tools

    Habitat Health

    Remote job

    At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. Habitat Health is growing, and we're looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit ****************************** Note: The estimated start date for this role is 12/1/2025 Role Scope: We are looking for a program manager to drive our Clinical and Strategic tools portfolio, specifically EMR and Growth engines. As a Program Manager you will work cross-departmentally to organize project planning, implementation, and training success. We are looking for a highly organized and dynamic individual who can juggle multiple projects across various applications; help implement and refine processes for intake, prioritization, and tracking of both projects and regular maintenance requests; and work closely with Platform and Operations leaders on end user training success. Develop and refine mechanisms to intake, prioritize, and track projects across multiple functions and systems Organize and facilitate meetings with business stakeholders and technical teams to drive project success Work with Operations leader to identify gaps in user training material and fill said gaps via documentation refinement and demo/training facilitation Partner with the PACE Center Leadership, Office of CMO, Population Health, Practice Operations, Finance, Strategy, Growth, and Health Plan Operations closely to define the business needs, direction and prioritization for Clinical Applications projects, and drive results. Coordinate with multiple vendors to drive project success including clarification of system function, collection of technical and operational documentation, and driving timely delivery of action items both internally and externally Qualifications Aligns with our purpose and our values, and is excited about living those out in daily practice PMP or similar certification 5+ Experience with Epic clinical applications (Ambulatory, Compass Rose) 5+ years of experience leading cross functional projects Strong ability to organize and refine project scope, requirements, and plan from ambiguous needs Excellent communication skills and ability to facilitate cross departmental meetings including senior leadership as well as line level staff Strong documentation skills, especially related to project planning spreadsheets and PowerPoint slides Proficiency with MS office suite and visualization tools (Vizio/Lucid) Nice to Have Experience with Salesforce Experience with Agile methodology including leading SCRUM PACE experience Compensation: We take into account an individual's qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $90,000 - $123,000. The actual offer will be at the company's sole discretion and determined by relevant business considerations, including the final candidate's qualifications, years of experience, skillset, and geographic location. How Habitat Health supports you: Medical, Dental, and Vision plans with competitive coverage for employees and dependents Health Savings Account with employer contribution Flexible Spending Account 12 weeks of fully paid Parental Leave for birthing and non-birthing parents 401k with match CME and License Reimbursements for clinical team members Short and Long Term Disability Voluntary Life Insurance Paid Vacation Time Paid Sick Time 10 company holidays Employee Assistance Program with access to mental health programs, legal and financial support, and much more! Vaccination Policy, including COVID-19 At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as and essential requirement of this role. Requests for reasonable accommodations due to an applicant's disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment. Our Commitment to Diversity, Equity, and Inclusion: Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law. Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at *************************. Beware of Scams and Fraud Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams' option: *******************************
    $90k-123k yearly Auto-Apply 53d ago
  • Clinical Program Success Manager, New Ventures

    Pomelo Care

    Remote job

    About us Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend. Role Description Your North Star: Deliver an exceptional experience to clinicians providing care to our Pomelo Care customers. Exceptional experience will be measured by: Clinician Net Promoter Score (NPS) Clinician quality metrics Clinician retention rates What You'll Do In this role, you will have the following responsibilities: Act as the primary internal point of contact for clinicians delivering care across our pilot programs; answer questions, provide feedback, and monitor utilization. Design the onboarding and training program for new clinicians, in partnership with the Training team, and ensure that all providers complete onboarding and training in a timely manner. Own communication and change management to clinicians regarding important updates, using scalable and effective methods. Maintain an up-to-date clinician handbook with accurate details on our offering, such as services included, documentation expectations, and required scripting. Ensure that clinicians meet the expectations of our client sponsors, including documentation requirements, quality standards, and preferred partners. Use data to identify areas for improvement at the individual and team level; escalate programmatic areas of opportunity and provide coaching to specific clinicians, as needed. Build relationships with relevant community clinician groups to support recruitment, build trust within the community, and stay informed of market trends. Who You Are Prior experience working within a healthcare environment, either as a clinician or as a team leader of clinicians. Strong interpersonal skills and demonstrated ability to engage with a diverse population. Demonstrated ability to build trusting relationships in a virtual environment. Excellent written and verbal communication skills. Demonstrated ability to drive change management with large frontline teams at scale. Comfort leading difficult conversations 1:1. Strong sense of ownership, with demonstrated experience partnering cross-functionally to find answers and to find solutions quickly and independently. Able to own processes end-to-end and ensure that all steps are completed accurately. Strong project management skills and attention to detail, ensuring that every step is understood accurately, completed in full, and communicated effectively. Comfort using data to inform prioritization and decision-making. Ability to adapt to changing priorities and work effectively in a fast-paced environment. Willingness to learn new processes and systems, and to teach them to others. Why you should join our team By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup where you will have a profound impact on the patients we serve. And you'll learn, grow, be challenged, and have fun with your team while doing it. We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first. We also offer: Competitive healthcare benefits Generous equity compensation Unlimited vacation Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship) At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status. Our salary ranges are based on paying competitively for our company's size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current salary range is $95,000-$110,000. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash. Potential Fraud Warning Please be cautious of potential recruitment fraud. With the increase of remote work and digital hiring, phishing and job scams are on the rise with malicious actors impersonating real employees and sending fake job offers in an effort to collect personal or financial information. Pomelo Care will never ask you to pay a fee or download software as part of the interview process with our company. Pomelo Care will also never ask for your personal banking or other financial information until after you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All official communication with Pomelo Care People Operations team will come from domain email addresses ending in @pomelocare.com. If you receive a message that seems suspicious, we encourage you to pause communication and contact us directly at ********************** to confirm its legitimacy. For your safety, we also recommend applying only through our official Careers page. If you believe you have been the victim of a scam or identity theft, please contact your local law enforcement agency or another trusted authority for guidance.
    $95k-110k yearly Auto-Apply 38d ago
  • Clinical Program Manager

    Histosonics 3.6company rating

    Remote job

    HistoSonics is a medical device company, founded in 2009, that has developed a non-invasive, sonic beam therapy platform that uses histotripsy, which is capable of destroying targeted liver tumors. Our mission and passion are to advance the novel science of histotripsy and its powerful benefits, bringing meaningful and transformational change to physicians and their patients. Location: Remote position, ideally candidates will live in a major metro area with an international airport. Travel Expectation: Travel (by automobile or air, day trips and overnight stays) up to 25% of the time. Position Summary: The Clinical Program Manager (Clinical PM) develops, manages and executes global clinical studies in collaboration with the Clinical Affairs team in accordance with applicable regulatory requirements and company's strategic imperatives. The Clinical PM manages all activities of study design and development, vendor management, site management including qualification, training, activation and monitoring. The Clinical PM will ensure study performance and compliance. Key Responsibilities: * Responsible for the management of Clinical Trials from inception through Clinical Study Report (CSR) completion. * Ensure clinical trial activities are completed on time, within budget and in a highly dynamic and complex environment in accordance with appropriate quality standards including ICH/GCP requirements. * Create and implement study-specific clinical monitoring tools and documents. * Lead the identification, evaluation, selection, and oversight of clinical trial sites. * Author and implement operational plans to ensure efficient study enrollment and monitoring activities at clinical sites. * Review/approve vendor and site invoices and track study budget to forecast, working closely with finance and clinical business operations. * Responsible for implementation and oversight of Trial Master File for inspection readiness. * Drive overall process and provide support to cross-functional teams in the development of study documents including study protocols, consent forms and budget templates. * Serve as lead in the creation of project plans, logs, templates, newsletters, and other documents. * Review and approve site specific documents (such as informed consent forms, site budgets, monitoring reports). * Provide study updates and reports, inclusive of study risks and issues. * Lead internal and external meetings, including Investigator Meetings, conferences, events and study management meetings. * Responsible for ongoing study data reviews and data cleaning activities. * Provide oversight of study activities such as site initiation, data quality, interim monitoring and close out activities. * Support the development of study training to investigators, site staff and internal staff. * Participate in the preparation and follow up of internal process audits, vendor, and study site quality audits as well as regulatory inspections. * Other duties as assigned. Qualifications and Skills: * Bachelor's degree in relevant area of study. * Minimum of 2-3 years clinical trial management experience; IDE trial experience preferred. * Minimum of 5 years experience in the medical device industry REQUIRED. * Knowledge of, and experience with, the FDA and the EU regulatory environments. * Excellent written and verbal communication skills. HistoSonics will not offer sponsorship or take over sponsorship of an employment visa for this position at this time. Benefits: We offer a comprehensive benefits package for full-time employees. This includes health, dental, and vision insurance, life, short-term and long-term disability insurance, 401(k), paid time off, and more. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. #LI-Remote
    $68k-107k yearly est. 26d ago
  • Manager, Clinical Services

    Us Heart & Vascular

    Remote job

    Job Details Remote, TX - Fort Worth, TX Fully Remote Full Time High School Diploma/GED Up to 10% Day Other PositionsRemote Manager - Cardiac Implanted Electrical Dev US Heart and Vascular is seeking a full time Remote Manager - Cardiac Implanted Electrical Device (CIED) Monitoring to join our team. The Manager will help launch and oversee a centralized team of Cardiac Device Specialists responsible for doing remote monitoring of CIEDs across our platform. The supervisor will be responsible for utilizing knowledge of electrophysiology to support device analysis, report generation, and communication with clinical care teams across the platform. This role serves as a leadership role for daily operations and clinical expert for CIED monitoring. Responsibilities & Duties Under the direct supervision of the operations director and in collaboration with physicians, the manager is responsible for: Supervising Cardiac Device Specialists inclusive of: Clinical supervision and oversight of Cardiac Device Specialists Ensure accurate and timely review of device transmissions Coordinate onboarding, training, and ongoing education for new and existing team members Provide feedback and coaching to ensure clinical excellence and protocol adherence Manage daily workflow and transmission volumes Run reports and reconcile various reports inclusive of error logs, interface logs, and billing reports Lead team huddles and meetings related to clinical aspects of CIED monitoring Providing CIED monitoring services inclusive of: Priority triage of transmission alerts Process all inbound transmissions and create docket reports in Murj clinical application Manage transmission schedules Collaborate with market operations and physicians to manage lost to follow-up patients Interpret Transmissions and Murj docket reports based on findings Cross-Reference device websites with Murj to ensure 100% Transmission conversion rate Contact Patients as Needed Integrate a knowledge base from physiology, pathophysiology, and cardiac device function to perform competent evaluations, diagnostic review, and overall analysis through remote monitoring Recognize abnormal functions of pacemakers, defibrillators, ILRs and CRT devices and recommend strategies to address and correct issues Communicate with clinical team and providers regarding CIED function and diagnostic data through accurate, professional, and standardized documentation Education Requirements: Associate degree in a medical field plus at least one year of experience in CIED remote monitoring or in-person evaluations or two years of experience in CIED monitoring (remote or in-person) without a formal degree License, Certification, Registration: International Board of Heart Rhythm Examiners (IBHRE) certification including CCDS, CDRMS, or CEPS is preferred. Certification will be required within one year of hire Knowledge, Skills, and Abilities Required: Efficient knowledge and usage of various device programmers such as Medtronic, Boston Scientific, Abbot, and St. Jude Medical Requires excellent communication and organizational skills Proficiency with Microsoft Office Suite - Outlook, Teams, Word, Excel, Power Point Must be able to function independently within the limits of the position Ability to function in a team environment Able to demonstrate interpersonal skills to be approachable and understandable to patients, families, and care team members Current BLS for Healthcare Providers certification
    $48k-77k yearly est. 60d+ ago
  • Clinical Program Manager - CMS Medical Review (RVC)

    Broadway Ventures 4.2company rating

    Remote job

    At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Location: Remote (U.S.) Schedule: Monday-Friday, 8:00 AM-4:30 PM ET Employment Type: Full-Time Position Overview We are seeking an experienced Program Manager to oversee daily operations for the CMS Review and Validation Contractor (RVC) Program. This role serves as the primary point of contact to the CMS RVC COR and is responsible for ensuring all contract, operational, and medical review requirements are executed in accordance with CMS guidelines. The ideal candidate brings a strong clinical background (RN), extensive Medicare program knowledge, and proven leadership experience managing large, complex healthcare projects. Key Responsibilities Serve as the contractor's authorized representative on all daily operational matters. Maintain ongoing communication with the CMS RVC COR regarding contract performance, staffing, and deliverables. Oversee medical review activities and ensure compliance with CMS guidelines and FFS RAC Program requirements. Lead cross-functional teams and manage staff required to support RVC operations. Ensure accurate interpretation of Medicare coverage, documentation, and regulatory standards. Monitor project progress, performance measures, and quality assurance outputs. Prepare operational updates, reports, and data summaries for CMS and internal leadership. Ensure effective workflows, staffing coverage, and adherence to deadlines and contract terms. Provide clinical oversight and guidance across medical review tasks and methodologies. Required Qualifications 5+ years of Program Management experience overseeing large or complex healthcare projects. Experience in medical review, healthcare auditing, or clinical review operations. Extensive knowledge of the Medicare program, including CMS regulatory and operational requirements. Working knowledge of the CMS FFS RAC Program. Strong leadership abilities with experience managing multidisciplinary teams. Education & Licensure Master's degree in Business, Healthcare Administration, Nursing, Management, or a related healthcare field from an accredited institution. Current, active U.S. Nursing License (RN); must be maintained throughout employment. Preferred Skills Excellent written and verbal communication skills. Strong analytical, organizational, and problem-solving abilities. Experience working with government contracts or federal healthcare programs. Ability to manage multiple projects and deadlines in a fast-paced environment. Why Join Us Opportunity to lead mission-critical work that supports the integrity of the Medicare program. Collaborative team environment with impactful clinical and operational responsibilities. Competitive compensation and benefits package. How to Apply Submit your resume detailing your program management experience, clinical background, and Medicare/CMS expertise. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.
    $62k-96k yearly est. Auto-Apply 13d ago
  • Project Manager - Clinical Research Pathology Services

    Deciphex

    Remote job

    Role Type and Location Work from home role - this role requires you to be based full time in the East Coast, USA. Eligibility to work Unfortunately, we cannot offer USA based Visa sponsorship for this full time USA BASED role. Role Summary We are seeking a proactive and detail-oriented Project Manager to support the delivery of pathology-focused clinical trial projects at Diagnexia Analytix. Sitting under the Clinical Trial Manager, this role will act as the operational driver of projects - ensuring that timelines, deliverables, and quality standards are met across complex, multi-stakeholder clinical studies. The Project Manager will not design the science, but will make sure the science happens: coordinating vendors, labs, pathologists, and internal teams, while keeping communication clear and projects audit-ready. Key Responsibilities Project Delivery & Coordination Translate Statements of Work (SoWs) into actionable project plans, timelines, and trackers. Manage day-to-day execution, logistics, and operational workflows. Oversee sample flow, staining, scanning, and digital pathology processes. Pathologist Management, training and communication Stakeholder Communication Serve as a central point of contact between sponsor, CRO, central labs, and internal teams. Organize and document sponsor calls, training sessions, consensus/adjudication meetings. Maintain action logs, decision records, and issue escalation pathways. Quality & Compliance Ensure all activities follow GCP/GCLP, ICH E6, and regulatory standards. Support preparation of validation reports, pathology manuals, final study reports, and archival outputs. Track QC metrics, deviations, CAPA actions, and maintain audit readiness. Risk & Change Management Maintain a risk register for timelines, logistics, and deliverables. Coordinate structured change control processes when scope or timelines shift. Required Skills & Experience (Must-Have) Degree in life sciences, biomedical sciences, or a related discipline. 3-5 years' experience in clinical trial project management, CRO operations, or translational/biomarker projects. Strong knowledge of GCP/GCLP and ICH E6 standards. Proven ability to deliver multi-stakeholder projects on time and within scope. Excellent organizational skills; able to manage multiple vendors, labs, and deliverables. Strong communication skills, with experience preparing reports, dashboards, and running status calls. Ability to anticipate issues, escalate appropriately, and drive solutions. Proficiency with project management tools (e.g., Smartsheet, MS Project, Asana) and shared document platforms. Preferred Skills & Experience (Nice-to-Have) Exposure to pathology, histology, or biomarker assay workflows. Experience coordinating pathologists and pathology vendors. Familiarity with digital pathology platforms (WSI, image hosting, secure data transfer). Therapeutic area experience in oncology, immunology, or liver disease trials. Formal PM certification (PMP, PRINCE2) or Lean/Agile training. Strong interpersonal skills: able to “manage up” to senior stakeholders while motivating delivery teams. Experience in a scale-up/fast-growing environment. Ideal Candidate Profile A “doer” who thrives on making things happen in complex clinical projects. Comfortable working alongside scientific leaders while taking responsibility for operations, timelines, and compliance. Highly organized, proactive, and able to bring structure and accountability to dynamic, multi-stakeholder studies. What are the benefits of working with Deciphex 💰 Competitive salary with annual performance-based increases. Rewarding your impact and growth 🩺 Healthcare benefits, giving you peace of mind to focus on what you do best 🌴 Annual leave with service increments - Means more time to recharge and enjoy life outside work 💡 Pension contributions, helping you build a secure future 🚀 Work with a world-class, high-performing team in a hyper-growth startup. You'll earn fast, make an impact, and shape the future 📈 Regular feedback and clear career growth opportunities. You keep developing and moving forward 🌍 A collaborative, supportive, multicultural team. Here you'll feel valued and inspired every day About the Company Through the work that we do, the team at Deciphex helps pharma to accelerate the process of essential drug development and helps patients to get timely and accurate diagnosis. Founded in Dublin in 2017, Deciphex has scaled rapidly to a team of over 180 people and counting who are providing software solutions to address the pathology gap in research pathology and clinical areas. We have offices in Dublin, Exeter, Oxford, Toronto and Chicago and are expanding our team throughout the world. We are software developers, clinical specialists, AI engineers, operations professionals and so much more, all working as one team to support our customers and patients. Our team culture is built on trust. We give our team the space they need to deliver results and the environment to ensure they can enjoy doing it. We are looking for highly motivated individuals who are excited to take on challenges and value making a difference in their day-to-day work. This is a unique opportunity to make a difference in the emerging Digital Pathology field. Read more about Deciphex here and more about our incredible team on our Careers Page here
    $66k-102k yearly est. 60d+ ago
  • Behavioral Health Services Manager

    Hope Family Health 3.8company rating

    Remote job

    Description - Behavioral Health Services Manager Original Board Approval Date 08/26/2020 Reports to Director of Behavioral Health Division Behavioral Health/Administrative Exempt/Non-Exempt Status Exempt Security Roles Clinical Administration; Clinical Care Specialist JOB SUMMARY: The Behavioral Health Services Manager plays a key role in supporting HOPE's integrated care model by helping oversee the day-to-day operations of the Behavioral Health (BH) department. This position provides direct supervision to BH nurses, medical assistants, and other support roles within the department, ensuring high-quality, patient-centered care. The Manager also serves as a vital administrative partner to the Director of Behavioral Health, offering clerical, programmatic, and operational support to help drive departmental goals, improve workflows, and maintain compliance with FQHC standards. Primary Duties & Responsibilities: Clinical Support: Demonstrates proficiency in all aspects of patient triage within the Behavioral Health department and completes competency assessments for both new and existing employees. Serves as a backup for the Behavioral Health medical assistant or nurse during periods of absence to ensure continuity of patient care and clinic operations. Human Resources & Staffing Support: Assists with the orientation and onboarding of new Behavioral Health staff, including interview coordination and preparation of new hire materials. Manages the department's weekly staffing schedule, including time-off approvals, timesheet submissions, missed punch corrections, and payroll approvals using ADP. Organizes and facilitates regular departmental meetings, including preparing agendas and documenting meeting minutes. Quality Improvement & Data Management: Supports departmental quality improvement efforts through data collection, analysis, and reporting. Tracks and reports on key indicators such as patient satisfaction, departmental expenses, and service utilization. Provides feedback and suggestions for process improvement based on insights from staff, patients, and community partners. Collaborates with the Director of Behavioral Health to develop and maintain spreadsheets and databases (e.g., Excel) to support budgeting and quality initiatives. Assists with the maintenance and updates of departmental forms and documentation. Community & Program Development: Educates patients, families, and community partners on available behavioral health services. Assists the Director of Behavioral Health in community outreach efforts to increase awareness and utilization of services. Represents the Behavioral Health department on internal committees, such as the Compliance/Risk Committee, Safety Committee, and Quality Assurance/Quality Improvement (QA/QI) Committee. Administrative & Operational Support: Provides general administrative support to the Director of Behavioral Health, including assistance with travel arrangements, training logistics, and expense reimbursements. Demonstrates adaptability and serves as a change agent to support ongoing departmental and organizational improvements. Supports teamwork and proactive communication among the Behavioral Health team and across departments. Intermittent Duties: Performs other duties as assigned by the Director of Behavioral Health to support departmental operations and organizational needs. Off-Site Work: Occasional off-site work is required for this position. With prior Team Leader approval, various job tasks may be completed remotely. These may include, but are not limited to: program development, policy and procedure updates, conference calls, grant writing, and similar administrative tasks. Employees approved for off-site work must have a confidential, designated workspace to ensure privacy and productivity. Off-site work classification and arrangements will be reviewed by the Team Leader at hire, during annual performance evaluations, and as needed throughout the year. Skills/Qualifications: Education & Experience: Some college coursework with 2-4 years of experience in a social or human services-related field, preferably with direct behavioral health experience. Bachelor's degree in a related field preferred. Specialized training or certifications (e.g., Non-Violent Crisis Intervention, Suicide Prevention/Intervention) are preferred. Technical & Professional Skills: Proficient in Microsoft Office Suite (Word, Excel, PowerPoint); ability to learn additional software and systems as needed. Strong organizational and time management skills, with the ability to prioritize tasks, meet deadlines, and manage multiple responsibilities. High-level problem-solving skills and sound judgment, with the ability to make independent decisions and consult with leadership when appropriate. Communication & Interpersonal Skills: Excellent verbal and written communication skills. Demonstrated cultural competency and the ability to engage effectively with individuals from diverse backgrounds. Strong interpersonal skills and a professional, customer-service-oriented demeanor. Other Key Competencies: Ability to take initiative and follow through on assignments with minimal supervision. Flexible, adaptable, and able to function effectively in a fast-paced, team-oriented environment. Personal Attributes: The Behavioral Health Services Manager must maintain strict confidentiality and consistently uphold HOPE's core values while performing all duties. The ideal candidate will demonstrate the following personal qualities: Trustworthiness and integrity Respectfulness toward patients, colleagues, and the community Cultural awareness and sensitivity to diverse backgrounds Flexibility and adaptability in a dynamic work environment Strong work ethic and commitment to excellence Working Conditions & Physical Demands: This position primarily functions in a professional office environment with periodic travel between HOPE sites. Occasional extended hours may be required based on organizational priorities. As a healthcare setting, employees may be exposed to body fluids and other potential health hazards. Requires sufficient visual acuity to read, write, and operate equipment commonly used in this role. Must be able to communicate effectively in English, both verbally and in writing; proficiency in a second language is helpful but not required. Requires adequate hearing ability to communicate effectively in person and by telephone. Occasionally required to lift items weighing up to 25 pounds. Note: This is intended to convey information essential to understanding the scope of the Behavioral Health Services Manager. It is not intended to be an exhaustive list of qualifications, duties, or responsibilities, as other duties may be assigned as needed. This job description follows the Americans with Disabilities Act (ADA) and the Fair Labor Standards Act (FLSA) (May 1995) HOPE Family Health Services is an equal opportunity employer who complies with applicable State and Federal civil rights laws and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disability status. Many positions at HOPE Family Health Services are funded in-part or in-whole by State or Federal Department of Health and Human Services funding and as such, our organization cannot employ individuals with certain criminal backgrounds or who are on State or Federal exclusion or debarment lists.
    $60k-91k yearly est. Auto-Apply 60d+ ago
  • Clinical Service Excellence Manager - Remote

    Access Telecare

    Remote job

    Who we are: Access TeleCare is the largest national provider of telemedicine technology and solutions to hospitals and health systems. The Access TeleCare technology platform, Telemed IQ, enables life-saving patient care through telemedicine and empowers healthcare organizations to build telemedicine programs in any clinical specialty. We provide healthcare teams with industry-leading solutions that drive improved clinical care, patient outcomes, and organizational health. We are proud to be the first provider of acute clinical telemedicine services to earn The Joint Commission's Gold Seal of Approval and has maintained that accreditation every year since inception. We love what we do and if you want to know more about our vision, mission and values go to accesstelecare.com to check us out. What you'll be responsible for: The Clinical Service Excellence Manager will be responsible for overseeing all clinical processes and serving as the client champion for Access TeleCare's Neurology programs. In this role, you will have the opportunity to build effective relationships with client stakeholders, develop clinician workflows, support new program implementation, create action plans to support service performance, and interface with clinicians to facilitate clinical excellence. In addition, this you will serve as the clinical point of contact for practice issues for partner sites. What you'll work on: Participate in program launches and support with the development of clinical workflows Maintain working rapport with individual providers covering the service as needed to address clinical workflow or practice issues, and communicating recommended changes to medical director and hospital(s) affected Build and maintain positive working relationships with partner facility clinical staff; train partner staff on tasks that promote clinical workflow efficiency such as cart coordination, and address concerns in a timely manner Analyze and present reports on healthcare processes and patient outcomes to identify and prioritize areas for improvement Coordinate performance improvement activities focused on specific patient services or organizational quality initiatives through the use of specific benchmarks and evidence-based practices Participate in efforts to establish and maintain organizational readiness to meet regulatory requirements based on service line specialty Collaborate closely with Neurology Practice Administrator and Service Line Chief to work on team initiatives, develop and report KPIs, identify opportunities within programs to improve communication, efficiencies, and processes What you'll bring to Access TeleCare: Bachelor of Science in Nursing from an accredited school of nursing At least three years of experience in neurology service line, inpatient services preferred (required) Prior experience as a charge nurse or nurse supervisor (preferred) Ability to navigate multiple EMR systems required Excellent computer skills and familiarity with Microsoft Office programs including Excel for data manipulation Excellent interpersonal communication skills and the ability to exercise empathy when working with patients and their families Excellent organizational and time management skills Demonstrate an understanding of standard clinical procedures, laws, and regulations Thorough knowledge of medical terminology Ability to work independently, but function as part of a team Work Environment and Schedule: High growth fast paced organization Primarily remote based environment Not more than 20 days travel to select sites annually Travel quarterly to corporate office in Dallas, TX Must be able to remain in a stationary position 50% of the time. Company perks: Health Insurance (Medical, Dental, Vision) Health Savings Account Flexible Spending (Medical and Dependent Care) Employer Paid Life and AD&D (Supplemental available) Flexible Vacation, Wellness Days, and Paid Holidays About our recruitment process: We don't expect a perfect fit for every requirement we've outlined. If you can see yourself contributing to the team, we would like to speak with you. You can expect up to 4 interviews via Zoom. Access TeleCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, age, religion, color, marital status, national origin, gender, gender identity or expression, sexual orientation, disability, or veteran status.
    $48k-77k yearly est. Auto-Apply 14d ago
  • Clinical Manager, Care Management Services (Remote)

    Author Health

    Remote job

    At Author Health, we're revolutionizing how mental health care is delivered, and we want you to be part of it! Our mission is to bring compassionate, high-quality care to people with serious mental illness, substance use disorders, and dementia, including older adults. We don't just treat symptoms. We treat people - fully, holistically, and with heart! Through our virtual-first, innovative care model, we deliver community-based wrap-around outpatient mental health care inclusive of psychiatric, psychotherapeutic and care management services. We partner with primary care providers, hospitals, families, and caregivers to keep patients out of the hospital and empower them to live healthier, more connected lives. At Author, inclusivity isn't a checkbox. It's how we build trust and drive better outcomes! We honor the unique cultures, identities, and stories that shape every patient's experience, and we're creating a workplace where team members can show up as their full selves, too. If you're driven by purpose, ready to shake up the status quo, and eager to make a real impact in people's lives, we'd love to meet you. Let's build the future of mental health care together! We are seeking a dynamic and experienced Clinical Manager of Care Management Services to oversee,coordinate, and deliver comprehensive care management services across both behavioral health and medical care settings. This clinical leadership role is critical in ensuring the seamless delivery of integrated care, optimizing patient outcomes, and promoting the efficient and effective utilization of resources within our organization. This Clinical Manager is expected to split his or her time between administrative / managerial responsibilities (typically ~60% of the time) and time serving patients directly (typically ~40% of the time). WHAT IS YOUR SUPERPOWER? Administrative & Managerial Responsibilities * Develop, implement, and oversee care management policies, procedures, and protocols for behavioral health and medical care. * Lead and supervise a multidisciplinary Care Management team organized in a "pod" model where: * Care Managers (Registered Nurses and Behavioral Health Care Managers) are responsible for comprehensive care planning and clinical coordination, * Licensed Practical Nurses (LPNs) focus on post-discharge outreach, coordination, and Transitional Care Management (TCM), while * Patient Resource Specialists (PRSs) support our patients by addressing health-related social needs and social determinants of health. * Manage care coordination processes across multiple payor environments, ensuring consistent standards of care, regulatory alignment, and effective operational workflows. * Ensure compliance with regulatory requirements related to care management and patient care. * Support the design and implementation of strategic initiatives that enable Author Health to innovate by piloting modifications or new builds in our care delivery model. * Participate in interdisciplinary meetings and committees to enhance coordination and communication across departments. * Coach members of the Care Management team to enhance performance on both clinical quality and overall efficiency - do so while using a data-driven approach, and by regularly shadowing and auditing individual team members (e.g., auditing calls and documentation). * Monitor and analyze data related to care management outcomes, utilization, and quality improvement initiatives. * Promote a culture of excellence, professionalism, and continuous improvement within the Care Management team. * Perform other duties as assigned to support departmental and organizational needs. Patient Care Delivery Responsibilities * Conduct regular assessments of patient needs, develop individualized care plans, and monitor progress towards goals. * Coordinate transitions of care and ensure continuity across different levels of care and health care settings. * Collaborate closely with interdisciplinary teams of health care providers both within and outside of Author Health, including physicians, nurses, therapists, and social workers, to ensure integrated care planning and delivery. * Serve as a resource for staff, patients, and families regarding care management services, resources, and community referrals. WHAT WE ARE SEEKING: * Bachelor's degree in Nursing; Master's degree preferred. * Experience building and leading teams * Minimum of 5 years of Nursing experience in care management, preferably in behavioral health or medical care settings. * Proven leadership and supervisory experience with strong team-building skills. * Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders. * Solid understanding of health care regulations, policies, and reimbursement practices. * Strong analytical skills and the ability to use data for decision-making and quality improvement. * Certification in Case Management (CCM, ACM, or similar) preferred WHAT WE OFFER: * Retirement savings plan (401k) Plan up to 3.5% company match * Low cost benefits package for employee and dependents ( medical/ dental/ vision/ STD/ Life Insurance) * Paid vacation * Paid sick leave * 9 paid holidays throughout the year with (2) additional flex holidays .. 11 in total! * Performance-based bonuses * and more! NEXT STEPS: * Submit an application * Upload an updated resume * Share LinkedIn profile and/or cover letter Author Health is committed to a diverse and inclusive workplace. It is the company's policy to comply with all applicable equal employment opportunity laws by making all employment decisions without unlawful regard or consideration of any individual's race, religion, ethnicity, color, sex, sexual orientation, gender identity or expressions, transgender status, sexual and other reproductive health decisions, marital status, age, national origin, genetic information, ancestry, citizenship, physical or mental disability, veteran or family status or any other basis protected by applicable national, federal, state, provincial or local law. The company's policy prohibits unlawful discrimination based on any of these impermissible bases, as well as any bases or grounds protected by applicable law in each jurisdiction. We are committed to providing an inclusive and accessible experience for all applicants. If you require any accommodations at any stage of the process, please let us know. The company is pleased to provide such assistance and no applicant will be penalized as a result of such a request. In accordance with applicable legal requirements such as the San Francisco Fair Chance Ordinance Author Health will consider for employment qualified applicants with arrest and conviction records. Monday through Friday, 8am-5pm EST
    $42k-71k yearly est. Auto-Apply 26d ago
  • Head of Enterprise Architecture (Managing Director), Evernorth Health Services (Hybrid)

    Accredo Health 4.8company rating

    Remote job

    We are seeking a strong leader (Band 6) in Enterprise Architecture to own and advance the end‑to‑end architecture strategy and be a consultative lead in two of our core segments: Pharmacy & Pharmacy Benefit Services (PBS). This role sets the north‑star architectural vision, guides multi‑year platform and data strategies, and influences senior leaders across technology and the business to accelerate transformation. The position requires executive presence to engage senior leadership, balancing high enterprise influence with support from a talented and focused team reporting to role. This is not a “keep-the-lights-on” role-this is for a transformational leader who thrives on challenging the status quo, building modern architecture, and enabling innovation across teams. Key Outcomes (first 12-18 months) North‑Star Architectural Vision for PBS & Pharmacy: Publish a business‑aligned target state and pragmatic multi‑wave sequence (platforms, data, integration, security), with measurable runway for core products and operations. Governance that Accelerates Delivery: Stand up/strengthen EA governance (principles, guardrails, decision logging) that reduces decision latency, aligns portfolio spend to goals, and increases adoption of reference patterns across Pharmacy/PBS domains. AI‑First Patterns in Priority Journeys: Operationalize responsible AI/GenAI patterns for experience enablement, digital personalization, and create new levels of efficiency in partnership with partners across technology and business. Step Function Change on Costs: Find roadmap to create new levels of effectiveness from operational and technology functions, creating lasting differentiation in client value proposition. Executive Advising & Alignment: Provide clear trade‑off narratives (cost, risk, velocity) to SLT/CIO partners; create durable alignment at major forks (build/buy/retire; sequencing; investment cases); become a trusted partner across enterprise, leading with vision and influence. Security & Compliance by Design: Ensure architectures and golden paths conform to Cigna Information Protection (CIP) standards and policies without burdening delivery teams. Key Responsibilities Strategy & Roadmap: Leveraging talent on team, define and maintain PBS and Pharmacy capability maps, platform strategy (buy/build/retire), reference architectures (cloud, data, API/eventing, streaming), and modernization waves tied to business outcomes. Governance & Decisioning: Establish and chair/participate in pragmatic architecture reviews; codify principles and decision records; instrument decision SLAs to remove bottlenecks and improve transparency. AI‑First Enablement: Embed responsible AI/GenAI designs (safety, observability, model governance) in pharmacy and PBS operations (e.g., clinical capabilities), digital experiences, and analytics products. Security, Risk & Compliance: Integrate CIP standards (e.g., change management, supplier security, data handling) into architecture guardrails and developer‑facing guidance; track adoption and exceptions. Delivery Partnership: Ensure architectures ship: define golden paths, reusable assets, and tooling; pair with engineering on first implementations; measure adoption and outcome impact. Talent & Community: Mentor principal architects and high‑potential ICs; curate communities of practice; maintain a living pattern library and decision log for learn‑once/use‑many scale. Qualifications 10+ years in enterprise architecture/technology strategy experience. Depth in modern architectures: public cloud (Azure/AWS), data platforms (warehouse/lake/lakehouse; streaming), API & event‑driven integration, zero‑trust, resilience/observability. (Market‑norm for distinguished‑level EA.) Demonstrated record designing and landing multi‑year platform and data strategies at enterprise scale. Executive presence with the ability to simplify complex decisions and drive change through influence (high enterprise impact with a lean direct span). Experience operationalizing corporate security & compliance standards within engineering practices (e.g., CIP). Excellent storytelling, facilitation, and stakeholder management with SLT and cross‑functional leaders. Experience in high-growth or transformational environments (startups, M&A, platform rebuilds). Systems thinker who balances ideal-state architecture with real-world execution. Nice to Have Prior PBM/specialty pharmacy platform knowledge (e.g., claims/benefit management, care coordination, specialty workflows). Earlier hands‑on engineering (software, data, or platform) before moving into architecture leadership. Industry credentials (e.g., TOGAF, Azure/AWS architecture) and/or published architecture patterns. Leadership Competencies Strategic Mindset, Drives Results, Collaborates, Instills Trust, Manages Complexity, Tech Savvy If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 203,500 - 339,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
    $64k-81k yearly est. Auto-Apply 60d+ ago
  • Clinical, Manager, Prior Authorization Technician

    Capital Rx 4.1company rating

    Remote job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Responsibilities: Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process. Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance. Actively participate in the prior authorization technician metric and quality goal setting process. Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders. Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees. Investigate/resolve escalated issues or problems from team members, clients, and other internal teams. Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions. Maintain relationships with external Independent Review Organizations and clinical resource vendors. Support the training and growth of both new and existing staff members in adherence to proper procedures. Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties. Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department. Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. Maintain compliance with local, state, and federal laws, in addition to established organizational standards. Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies Required Qualifications: Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required Bachelor's or Associate's degree is preferred 4+ years of PBM or Managed Care pharmacy experience required Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint Strong clinical background required Excellent communication, writing, and organizational skills Ability to multi-task and collaborate in a team with shifting priorities Preferred Qualifications: 2+ years of regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements Previous prior authorization operations leadership experience Salary Range$80,000-$90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************
    $80k-90k yearly Auto-Apply 6d ago
  • Head of Enterprise Architecture (Managing Director), Evernorth Health Services (Hybrid)

    Cigna 4.6company rating

    Remote job

    We are seeking a strong leader (Band 6) in Enterprise Architecture to own and advance the end‑to‑end architecture strategy and be a consultative lead in two of our core segments: Pharmacy & Pharmacy Benefit Services (PBS). This role sets the north‑star architectural vision, guides multi‑year platform and data strategies, and influences senior leaders across technology and the business to accelerate transformation. The position requires executive presence to engage senior leadership, balancing high enterprise influence with support from a talented and focused team reporting to role. This is not a “keep-the-lights-on” role-this is for a transformational leader who thrives on challenging the status quo, building modern architecture, and enabling innovation across teams. Key Outcomes (first 12-18 months) North‑Star Architectural Vision for PBS & Pharmacy: Publish a business‑aligned target state and pragmatic multi‑wave sequence (platforms, data, integration, security), with measurable runway for core products and operations. Governance that Accelerates Delivery: Stand up/strengthen EA governance (principles, guardrails, decision logging) that reduces decision latency, aligns portfolio spend to goals, and increases adoption of reference patterns across Pharmacy/PBS domains. AI‑First Patterns in Priority Journeys: Operationalize responsible AI/GenAI patterns for experience enablement, digital personalization, and create new levels of efficiency in partnership with partners across technology and business. Step Function Change on Costs: Find roadmap to create new levels of effectiveness from operational and technology functions, creating lasting differentiation in client value proposition. Executive Advising & Alignment: Provide clear trade‑off narratives (cost, risk, velocity) to SLT/CIO partners; create durable alignment at major forks (build/buy/retire; sequencing; investment cases); become a trusted partner across enterprise, leading with vision and influence. Security & Compliance by Design: Ensure architectures and golden paths conform to Cigna Information Protection (CIP) standards and policies without burdening delivery teams. Key Responsibilities Strategy & Roadmap: Leveraging talent on team, define and maintain PBS and Pharmacy capability maps, platform strategy (buy/build/retire), reference architectures (cloud, data, API/eventing, streaming), and modernization waves tied to business outcomes. Governance & Decisioning: Establish and chair/participate in pragmatic architecture reviews; codify principles and decision records; instrument decision SLAs to remove bottlenecks and improve transparency. AI‑First Enablement: Embed responsible AI/GenAI designs (safety, observability, model governance) in pharmacy and PBS operations (e.g., clinical capabilities), digital experiences, and analytics products. Security, Risk & Compliance: Integrate CIP standards (e.g., change management, supplier security, data handling) into architecture guardrails and developer‑facing guidance; track adoption and exceptions. Delivery Partnership: Ensure architectures ship: define golden paths, reusable assets, and tooling; pair with engineering on first implementations; measure adoption and outcome impact. Talent & Community: Mentor principal architects and high‑potential ICs; curate communities of practice; maintain a living pattern library and decision log for learn‑once/use‑many scale. Qualifications 10+ years in enterprise architecture/technology strategy experience. Depth in modern architectures: public cloud (Azure/AWS), data platforms (warehouse/lake/lakehouse; streaming), API & event‑driven integration, zero‑trust, resilience/observability. (Market‑norm for distinguished‑level EA.) Demonstrated record designing and landing multi‑year platform and data strategies at enterprise scale. Executive presence with the ability to simplify complex decisions and drive change through influence (high enterprise impact with a lean direct span). Experience operationalizing corporate security & compliance standards within engineering practices (e.g., CIP). Excellent storytelling, facilitation, and stakeholder management with SLT and cross‑functional leaders. Experience in high-growth or transformational environments (startups, M&A, platform rebuilds). Systems thinker who balances ideal-state architecture with real-world execution. Nice to Have Prior PBM/specialty pharmacy platform knowledge (e.g., claims/benefit management, care coordination, specialty workflows). Earlier hands‑on engineering (software, data, or platform) before moving into architecture leadership. Industry credentials (e.g., TOGAF, Azure/AWS architecture) and/or published architecture patterns. Leadership Competencies Strategic Mindset, Drives Results, Collaborates, Instills Trust, Manages Complexity, Tech Savvy If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 203,500 - 339,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
    $81k-98k yearly est. Auto-Apply 60d+ ago

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