Clinical services director work from home jobs

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

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.

## **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

RIMA, a Radiology Partners practice, is looking for a high quality radiologist to fill a full-time Remote Reader position in our practice. This position will interpret primarily emergency imaging. Candidates must be residency-trained in Diagnostic Radiology and share a vision for an integrative and collaborative care model with a multi-disciplinary team. We have a commitment to quality and ardently promote and invest in the professional development of our radiologists through quality and leadership programs. Candidates must be residency-trained in Diagnostic Radiology and Board-Certified or Board-Eligible in Diagnostic Radiology. Ability to interpret general and advanced emergency radiology studies is required. We offer highly competitive compensation with an opportunity for partnership, as well as competitive salary and benefits including malpractice insurance coverage, 401K, CME discounts, disability coverage and healthcare reimbursement. POSITION DUTIES AND RESPONSIBILITIES * 7 days on and 7 days off (5am EST-2pm EST) "END Time is Negotiable" * Remote reading from home * Interpret emergency (STAT ER, urgent care and inpatient) imaging for several facilities in our practice * Work 26 weeks and enjoy 26 weeks off * Partnership track position DESIRED PROFESSIONAL SKILLS AND EXPERIENCE * Candidates must be a Doctor of Medicine or Osteopathy, Board-certified/Eligible in the practice of Diagnostic Radiology * Current California licensure is preferred, ultimately required for the position * Neuroradiology fellowship preferred * Fellowship trained in Neuro, Emergency Radiology, body, MSK, or Pediatrics is preferred COMPENSATION: The salary for this position is $600,000. Final determinations may vary based on several factors including but not limited to education, work experience, certifications, geographic location etc. This role is also eligible for an annual discretionary bonus. In addition to this range, Radiology Partners offers competitive total rewards packages, which include health & wellness coverage options, 401k benefits, and a broad range of other benefits such as family planning and telehealth (all benefits are subject to eligibility requirements). FOR MORE INFORMATION OR TO APPLY For inquiries about this position, please contact Misha Hepner at ************************** or ************. PRACTICE OVERVIEW Radiology Partners, through its affiliated practices, is a leading radiology practice in the U.S., serving hospitals and other healthcare facilities across the nation. As a physician-led and physician-owned practice, we advance our bold mission by innovating across clinical value, technology, service and economics, while elevating the role of radiology and radiologists in healthcare. Using a proven healthcare services model, Radiology Partners provides consistent, high-quality care to patients, while delivering enhanced value to the hospitals, clinics, imaging centers and referring physicians we serve. Radiology Partners is an equal opportunity employer. RP is committed to being an inclusive, safe and welcoming environment where everyone has equal access and equitable resources to reach their full potential. We are united by our Mission to Transform Radiology and in turn have an important impact on the patients we serve and the healthcare system over all. We hold that diversity is a key source of strength from which we will build a practice culture that is inclusive for all. Our goal is to empower and engage the voice of every teammate to promote awareness, compassion and a healthy respect for differences. CCPA Notice: When you submit a job application or resume, you are providing the Practice with the following categories of personal information that the Practice will use for the purpose of evaluating your candidacy for employment: (1) Personal Identifiers; and (2) Education and Employment History. Radiology Partners participates in E-verify. Beware of Fraudulent Messages: Radiology Partners will never request payment, banking, financial or personal information such as a driver's license in exchange for interviews or as part of the hiring process. Additionally, we will not send checks for deposit into your bank account at any stage of recruitment. All communication during the interview and hiring process should come from an email address ending in "@radpartners.com." If you suspect you are receiving a fraudulent job offer or solicitation from Radiology Partners or one of our local practices, please notify our Recruiting Team at **************************.

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.

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.

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

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: *******************************

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.

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 ******************. 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.

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

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

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 *********************************************

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.

Click here to view our 2026 Benefits Guide Serves as the clinical expert in key healthcare domains, including infection control, wound care, surgical procedures, vascular access, LVAD (Left Ventricular Assist Device), Durable Medical Equipment (DME), Remote Patient Monitoring (RPM), and related product categories. Leads expert clinical support for field sales teams to help achieve strategic business objectives and drive revenue growth. Leads the planning and execution of product evaluations, customer training sessions, and implementation initiatives for both internal stakeholders and external healthcare professionals. Develops and delivers professional education programs, including the creation of training materials and presentations, often acting as lead presenter and project manager. Plays a critical role in shaping the customer experience across the sales lifecycle-from initial engagement and product adoption to long-term satisfaction-impacting training outcomes, product utilization, purchasing decisions, and overall customer retention. Essential Functions (ACCOUNTABILITIES/RESPONSIBILITIES): Serves as a clinical and education expert, providing training and support to internal teams, customers, distributors, and white-label partners across the full Bravida product portfolio. Leads field-based product evaluations, implementations, and maintenance activities, including account setup and tailored training plans that directly support sales success. Leads training for field sales representatives (direct and 1099), and for the training, supervision, and mentorship of per diem clinical staff and clinical education specialists ensuring clinical competence, brand consistency, and measurable ROI from training investments. Drives the development and execution of Bravida Academy offerings, taking the lead in multiple education programs with significant influence on customer success and learning outcomes. Contributes to CE accreditation processes as needed. Conducts customer needs assessments in response to field complaints, identifying trends, ensuring compliance with internal processes in partnership with RAQA, and recommends targeted training and troubleshooting strategies to field sales and clinical teams. Leads and executes training programs for all internal colleagues and external customers, fostering long-term clinical skill development and amplifying the voice of the customer across Bravida teams. Develops and maintains strategic relationships with KOLs (Key Opinion Leaders), overseeing consultant-led educational content, poster presentations, speaking engagements, and related projects. Represents Bravida as an active member of professional organizations, delivering presentations, authoring content, and coordinating outreach and training at local, regional, and national events, conferences, and trade shows. Maintains current expertise in clinical practice guidelines, FDA and regulatory standards, market trends, and competitor products; contributes to content and document review in QT9 quality management system. Provides clinical input to New Product Development (NPD) and R&D teams, shaping portfolio innovation and supporting training strategy for product launches. Leads clinical research activities, including Bravida-sponsored trials, ensuring alignment with FDA requirements and Good Clinical Practice (GCP) standards from initiation to completion. Collaborates cross-functionally with the CCLO, Marketing, and Sales teams to develop and deliver clinical messaging, sales tools, and customer-centric educational content; drives continuous improvement through feedback integration. Delivers clinical education using a variety of digital platforms (e.g., On24, eLearning tools, websites) and stays current with best practices in remote and virtual training technologies. Utilzes Bravida business systems (e.g., SFDC, Fast Field, Monday.com, IntelAgree) for planning, communication, project tracking, and deliverable management. Sets an example and ensures full compliance with Bravida policies, procedures, Code of Conduct, and the organization's mission and values. Qualifications: Experience 5+ years of clinical nursing experience in one or more of the following areas: Operating Room, Wound Care, Infection Control, Vascular Access, and/or Critical Care, with a strong foundation in patient care and clinical protocols. 3-5 years of experience in a nursing manager and/or educator role, demonstrating leadership in staff development, training programs, and clinical oversight. 3-5 years of experience in the medical device industry preferred, with a focus on direct customer engagement, clinical field support, educational content development, and training delivery. Education Bachelor's Degree in Nursing (BSN) preferred. Master's Degree in Nursing (MSN) or Business Administration (MBA) preferred. Credentials Registered Nurse (RN), licensed and in good standing, required. Accredited Nursing Certifications (e.g., Wound Care Certification [WCC], Perioperative Nurse [CNOR], Infection Control [CIC], Critical Care Registered Nurse [CCRN]) preferred. General Skills/Competencies/Specialized Knowledge Strong clinical competencies in areas such as Operating Room, Wound Care, Infection Control, Vascular Access, and Critical Care. In-depth understanding of the healthcare industry, market trends, and the evolving role of medical devices in clinical practice. Proficient expertise in clinical program design for the medical device industry, with the ability to link clinical needs to business outcomes. Proven effectiveness in supporting sales teams through customer training, product utilization, and decision-making support to drive business objectives. Competent leadership and project management skills, including the ability to collaborate across departments and lead processes effectively to meet or exceed deadlines. Training content development and strong presentation skills with a proven track record of success in educational settings. Exceptional communication, interpersonal, and negotiation skills, with a focus on building long-term professional relationships. Strong problem-solving abilities in complex clinical and business environments. Competence in digital tools and platforms, including PPT, Excel, Power BI, eLearning, digital conference and webinar platforms with high-quality content delivery. Desirable Job Competencies Ambition and drive to grow within the company and the industry. Ability to juggle multiple tasks simultaneously with a sense of urgency, prioritizing competing priorities in a fast-paced environment, ensuring timely delivery without compromising quality. Ability to build strong relationships with internal teams, customers, and professional organizations. Leadership potential with the ability to manage projects and initiatives to completion. Innovative, creative thinker with a focus on customer experience and high-quality outcomes. High clinical confidence with the ability to navigate and influence complex healthcare systems. Expertise in networking and driving sales, contributing to customer conversion and retention. TRAVEL REQUIREMENTS/WORK ENVIRONMENT and PHYSICAL DEMANDS: Travel Requirements Willing and able to travel up to 80% for customer-facing activities, including product evaluations, conversions, ongoing support, and educational training sessions in the field. Work Environment & Physical Demands Must be able to lift and carry items up to 30 lbs. as needed for demonstrations and training setups. Requires frequent walking and standing in various settings, including acute care hospitals, conference centers, airports, and other customer locations.

The Clinical Manager is responsible for developing and implementing clinical training curricula detailing the application and fitting of the designated Etac product area to achieve positive functional outcomes. This position trains providers, therapists, and sales associates in the form, fit, and function of Etac products and their clinical applications. This is a traveling position providing product presentations, clinical in-services, and product/client fittings with providers and/or clinicians and provides one-on-one training with sales associates with the goal of supporting efforts to increase sales of all designated Etac products. The role also supports and leads larger in-person clinical product education and training engagements with key customers. Product Areas: Seating & Positioning: all Etac North America Mobility custom and “packaged” seating products, including Axiom, Axiom Kids, Axiom Custom Back, Axiom Custom Seating, Star Cushions, secondary positioning supports, and other products and accessories as they may be designated in the future. Mobility: all Etac North America Mobility manual wheelchairs and related accessories or components, including power assist. This includes manual wheelchair in the folding, rigid, tilt-in-space, pediatric and adolescent categories, as well as, any products and accessories as they may be designated in the future. Pediatrics: all Etac North America Mobility products intended for use by the pediatric population. This includes all products, accessories, or components from R82, Convaid, Ki Mobility, including power assist. This will also include any products and accessories as they may be designated in the future. Essential FunctionsJob Responsibilities Assist in the development of clinical training curricula relating to relevant Etac products. Create and deploy training materials that will be used by sales associates, export partners, and other clinical education team members. Establish and maintain a travel schedule with Etac sales associates centered around in-field customer and clinician engagements. Attend trade shows, customer events, and sales meetings as necessary. Contribute to the development of the company's strategic plan to drive future growth and profitability for relevant Etac products. Present professional continuing education content (CEUs) as needed, either through coordination with sales associates and managers, or at key business partner education events. Manage sales expenses within the guidelines of the Company expense policy. Work closely with the sales team, specifically Territory Sales Managers, to align training initiatives with sales strategies and customer needs. Collaborate with cross-functional teams to align and deliver product education and training programs. Uphold Company values and ethical business conduct, as well as, maintain confidentiality of sensitive information. Utilize sales and order analysis tools, including Qlik, to strategically plan and prioritize travel to optimize effectiveness. Utilize sales and order analysis tools, including Qlik, post-travel to analyze effectiveness of travel and/or training curricula. Be a key contributor to product development requirements around competitive opportunity, clinical requirements and efficacy that deliver strong new product enhancements that meet market needs. Ensure and follow safety, quality, and other company requirements and standards. Keep the work area clean and orderly. Perform all duties in a manner that follows, demonstrates, and promotes Company's values. Report to work as scheduled, on time, and able to work entire work schedule. Perform additional duties as assigned. Knowledge, Skills, and Ability Excellent presentation skills and confidence in front of small and large groups. Strong organizational skills. Strong Microsoft PowerPoint skills. Knowledge and proficiency with Microsoft Office Suite products, including Excel and Outlook, and other enterprise software. In depth knowledge of clinical issues relating to disabled populations. Knowledge of manual mobility and seating products than span adult and pediatric solutions within the complex rehabilitation industry. Ability to establish and maintain professional communications both inside and outside the company. Funding knowledge within complex rehab technology. Ability to network with providers, ATP's, clinicians, and caregivers. A high level of interactive communication is required to service our customers and clinicians; must be able to respond quickly and effectively to satisfy customer and clinician inquiries. Possess a strong business acumen with an understanding of market potential and contract development. Analytical skills in order to solve complex problems and make informed decisions. Possess excellent written and oral communication and interpersonal skills to collaborate effectively with cross-functional teams. Proactive and self-motivated with the ability to work independently and in a team environment. Ability to lift and handle wheelchairs. Ability to observe and identify details. Ability to work extended hours as scheduled, including weekends. Physical Demands Frequent sitting, wrist manipulation, walking, and standing. Frequent bending, pushing, pulling, and twisting. Occasional to frequent driving in a vehicle. Frequent light/medium work with lifting up to 30 pounds. Occasional medium work with lifting up to 50 pounds. Must be able to lift, handle, load, and unload all products. Manual dexterity to type and operate office equipment frequently. Must be able to complete all physical requirements to perform essential functions. QualificationsEducation/Experience Degree in a clinical discipline (Occupational or Physical Therapy, Kinesiology) or a related field or 3-5 years of experience in the complex rehab industry. ATP certification is beneficial. Must possess and maintain a valid driver's license. Intermediate level experience with computer applications. Working Environment Remote position with an expectation of up to 75% travel focusing on specific key referral sources, their clinicians, providers, and ATP's. This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the associate for this position. Duties, activities, and responsibilities may change, or new ones may be assigned at any time with or without notice. Associate must be able to satisfactorily perform the essential functions of the position with or without reasonable accommodations. Ki Mobility is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

Clinician I Hiring Range: $70,387.20 to $93,828.80 Pay Range: $70,387.20 to $105,560.00 Clinician II Hiring Range $75,296.00 to $100,401.60 Pay Range $75,296.00 to $112,964.80 Hiring Incentives Sign-on bonus Relocation Package Retention Bonus Referral Bonus Job Summary: The Southcentral Foundation (SCF) Clinician is responsible for providing clinical interventions tailored to the customer-owner needs and prepare them for participation in learning circles. This position has two (2) levels designed to provide progressively more responsible and independent work experiences. Progression between job levels is based on the demonstrated ability to successfully handle more progressively responsible assignments. Southcentral Foundation is seeking exceptional Clinicians to join our Intensive Home Based Treatment program at Child and Family Outpatient Services in Anchorage. Do you enjoy working with children, teens and their caregivers? CFOS Intensive Home Based Treatment offers opportunities for Clinicians to provide therapy in the community and in customer-owner residences. IHBT Clinician's will work alongside Community Case Managers to collaborate and provide services to youth at risk of out-of-home placement. IHBT works to build stronger relationships and bonding between youth and their families. We believe that youth heal best with their families, in their homes. This position will require a flexible schedule that will include one weekend day and night availability. SCF programs are established to serve a primary population comprised of Alaska Native people who are affiliated with Cook Inlet Region, Inc. (CIRI) and Alaska Native and American Indian people within SCF's geographical service area. Employees should have a thorough understanding of the cultures and the needs of this population. Such knowledge is critical to ensure the achievement of SCF's vision of a Native Community that enjoys physical, mental, emotional, and spiritual wellness, and mission of working together with the Native Community to achieve wellness through health and related services: Qualifications: 1. Master's degree in behavioral health field including Counseling, Psychology or Social Work; OR PhD/PsyD in Clinical or Counseling Psychology. 2. Obtain Alaska Clinical Licensure in designated field within four (4) years of hire. Additional Qualifications for Clinician II: Meets all requirements of Clinician I in addition to the following: 1. Two (2) years of supervised clinical work experience for Master's level Behavioral Health; OR two (2) years of post-graduate clinical experience for PhD or PsyD level; OR demonstrated proficiency as a Clinician I at SCF. 2. Current Alaska Clinical Licensure in designated field. · Valid Alaska driver's license that meets State of Alaska Division of Motor Vehicles (DMV) license requirements to include: May drive in Alaska for up to 90 days with a valid out-of-State license, then must obtain an Alaska driver's license. · No more than three (3) moving traffic violations (as defined by Alaska Statutes Title 28); OR two (2) at-fault traffic accidents in the previous three (3) years. · The driver must not have had ‘Driving Under the Influence' (DUI); OR ‘Driving While Intoxicated' (DWI); OR ‘Operating Under the Influence' (OUI) violations as follows: Zero (0) violations in the past five (5) years. No more than two (2) violations in the past ten (10) years. · Drivers must be at least 18 years of age. Drivers 18 through 20 years of age may only transport equipment, materials, and employees. Drivers who transport customers must be 21 years of age or older and must have completed the probationary period of license requirements for Alaska. · Prior to hire date, must provide current copy no more than 60 days old of driving record from issuing State. Native Preference: Under P.L. 93-638, as amended, the company pursues a policy of Native preference in hiring, contracting and training. SCF Human Resources must receive certification before applicants receive preference. Employee Health Requirements: Compliance with our Employee Health Procedure is a condition of SCF employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs designated as a Health Care Personnel (HCP) position, requires that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required. #INDBSD

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.

Join the BlueCare team at BCBST as a Clinical Review Manager! In this role, you will complete medical reviews for utilization management within the BlueCare member population. You'll have the opportunity to collaborate with the BlueCare Utilization Management team, Case Managers, and other departments. The ideal candidate for this role is a quick learner who thrives in a role that requires attention to detail and research skills. The role also requires the ability to navigate clinical information and disseminate it in a timely manner. Finally, we're looking for a candidate with strong communication skills to be able to work effectively across multiple teams. Key Schedule Details: Typical schedule is 8-5 pm EST or 9-6 pm EST. Fully remote, at home position. There is an option, upon management approval, for alternative workdays or a compressed work schedule. For example, the Clinical Review Manager may work five 8-hour shifts or four 10-hour shifts, which may include a combination of weekdays and weekends (e.g., Wednesday-Sunday or Thursday-Sunday)." Join our team and make a significant impact on the quality of care our members receive! Job Responsibilities Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Assists non-clinical staff in performance of administrative reviews Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. Occasional weekend work may be required. Must be able to pass Windows navigation test. Testing/Assessments will be required for Digital positions. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required Skills\Certifications Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Working knowledge of URAC, NCQA and CMS accreditations Must be able to work in an independent and creative manner. Excellent oral and written communication skills Strong interpersonal and organizational skills Ability to manage multiple projects and priorities Adaptive to high pace and changing environment Customer service oriented Superior interpersonal, client relations and problem-solving skills Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.