Clinical services director work from home jobs - 506 jobs

Join the team leading the next evolution of virtual care. At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives. Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens. Summary of Position Teladoc Health is seeking an experienced physician to serve as Medical Director, Cardiometabolic Clinical Care Model Design and Client Engagement. This physician leader will serve in a highly cross-functional role instrumental in shaping the future of cardiometabolic care at Teladoc Health, particularly within our U.S. Group Health Business, advancing clinical excellence across existing chronic condition management solutions while building and scaling novel approaches. This role will continue to champion seamless integration of cardiometabolic care across our expansive ecosystem of virtual primary care, urgent care, mental health, expert medical/specialty care, and more. This is an individual contributor leadership position requiring strong clinical expertise in cardiometabolic care and the ability to work strategically in the complex and rapidly evolving virtual care/digital health space. Success in this role requires close cross-functional collaboration with diverse stakeholders to enhance care delivery models, achieve best-in-class clinical outcomes, and optimize return on investment. The candidate will support value-based care partnerships and drive clinical research to strengthen the evidence base for virtual cardiometabolic care. Additionally, this physician leader must be able to translate these efforts into client-facing strategies, partnering with employers and payers to help them understand and achieve better health outcomes for their populations. Essential Duties and Responsibilities Serve as the clinical lead for designing cardiometabolic care models across new and existing capabilities within the U.S. Group Health business. Lead clinical and cross-functional teams to design, pilot, and scale innovative integrated cardiometabolic care models, working closely with front-line providers and care teams. Translate population health data and risk stratification into actionable program strategies. Define success metrics-including clinical outcomes and financial ROI-and develop strategies for sustained impact. Work closely with internal teams-including sales, marketing, and client-facing groups-providing clinical expertise for key presentations and client discussions. Represent the organization externally on topics related to chronic condition management and cardiometabolic care innovation. Develop and refine chronic condition management frameworks, measures, and reporting aligned with the Institute for Healthcare Improvement Quadruple Aim and Institute of Medicine quality domains: safety, effectiveness, patient-centeredness, efficiency, timeliness, and equity. Co-lead formal quality improvement projects using the Model for Improvement with a focus on process and outcome metrics and leveraging statistical process control (SPC) where appropriate. Partner with our Clinical Research team to generate evidence and insights for white papers and peer-reviewed publications demonstrating the impact of our cardiometabolic solutions. The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs. Supervisory Responsibilities No Required Qualifications MD/DO in Internal Medicine, Family Medicine, or a cardiometabolic specialty; active medical license preferred At least 5+ years of post-residency or fellowship clinical experience Experience in virtual care, digital health, or healthcare technology, with the ability to adapt to rapid change and ambiguity. Demonstrated expertise in delivering evidence-based clinical care model design, clinical quality improvement, outcome measurement. Exemplary written and verbal communication skills, including the ability to explain complex clinical concepts to non-clinical audiences. Proven ability to collaborate effectively across clinical and non-clinical teams, including operations, product, engineering, marketing, commercial, and other functions in a highly matrixed environment. Strong prioritization, time management, and organizational skills, with meticulous attention to detail. Ability to thrive in fast-paced, dynamic environments with multiple competing priorities and deadlines. Preferred Qualifications Experience in dedicated virtual care/digital health organizations focused on cardiometabolic conditions. MBA/MPH and/or advanced quality improvement training preferred. Demonstrated experience delivering virtual care, particularly in primary care and cardiometabolic management beyond the COVID-19 pandemic. Expertise in value-based care delivery with track record of maximizing clinical outcomes while managing total cost of care. Required license or credential needed to perform job: MD/DO The above qualifications, knowledge, experience, and/or background are expected but not required for this role. Work Environment ☐ Office ☒ Remote ☐ Hybrid (Office & Remote) Travel: ≥10% Travel percentage reflects an estimate and is subject to change dependent on business needs. The base salary range for this position is $210,000 - $240,000. In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2026. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions. As part of our hiring process, we verify identity and credentials, conduct interviews (live or video), and screen for fraud or misrepresentation. Applicants who falsify information will be disqualified. Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future. Why join Teladoc Health? Teladoc Health is transforming how better health happens. Learn how when you join us in pursuit of our impactful mission. Chart your career path with meaningful opportunities that empower you to grow, lead, and make a difference. Join a multi-faceted community that celebrates each colleague's unique perspective and is focused on continually improving, each and every day. Contribute to an innovative culture where fresh ideas are valued as we increase access to care in new ways. Enjoy an inclusive benefits program centered around you and your family, with tailored programs that address your unique needs. Explore candidate resources with tips and tricks from Teladoc Health recruiters and learn more about our company culture by exploring #TeamTeladocHealth on LinkedIn. As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status, or pregnancy). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind. Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health's Notice of Privacy Practices for U.S. Employees' Personal information is available at this link .

This opportunity will be on-site in Washington. Cornerstone, part of The Pennant Group family, is currently seeking entrepreneurial-minded leaders with proven results in building and leading exceptional clinical teams - and has a passion for the home health, hospice and home care industry. Join us in making an impact and shaping the future of home healthcare! About the Opportunity: The CCO-in-Training (CCIT) Program is a 12-week, full time paid executive training program designed to prepare outstanding leaders for an opportunity to lead and manage clinical services and teams in a home health, hospice, or home care setting. CCITs learn how to drive results, cultivate a strong team culture, and develop a deep understanding of the unique business model that powers Pennant's success. Successful CCIT graduates may advance to lead one of our thriving agencies or future agencies, with continued mentorship and operational support from experienced clinical partners. As a CCIT, you will gain hands-on practical experience in high quality clinical care services, agency operations, administrative support, and people leadership skills to equip you to take on a more strategic and elevated Director of Clinical Services position (or equivalent). The CCIT program offers mentorship, cross-functional training, and real responsibility in a dynamic environment. Key Responsibilities: Engage in immersive, on-the-job training across clinical, operational and administrative management functions. Shadow department heads and front-line staff to understand the day-to-day rhythm of agency operations, processes, and clinical controls. Take the lead on real-time projects and contribute to meaningful improvements within your host agency. Prepare for a Director-level role by mastering staffing, team engagement, and community growth initiatives. Study relevant state regulations and best practices in home healthcare operations. Align leadership and interpersonal skills with our CAPLICO core values and mission. Qualifications: Current, unencumbered, active license to practice as a Registered Nurse, Speech-Language Pathologist, Occupational Therapist, or Social Worker in the state where services are rendered; must maintain applicable state licensure requirements at hire, and for the entire duration of employment. Minimum of one (1) year of experience required, preferably in a home health or hospice treatment setting. Current and nationally accredited CPR certification. Enthusiasm, passion for working with people, and an internal drive to improve the lives of individuals in our care. Must understand and adhere to the ethical standards of the respective licensure governing board. Must have a valid driver's license, current automobile insurance, and a safe driving record. Open to relocation based on available opportunities About Us: Cornerstone, an affiliate of The Pennant Group (NASDAQ: PNTG), is committed to delivering compassionate, personalized care to patients and families in the comfort of their own homes. As part of the Pennant family-a growing national network with over 180 affiliated locations across 14 states spanning home health, hospice, and senior living-we operate with the independence and flexibility that allow our local leaders to truly make a difference. Pennant Services provides robust clinical, legal, accounting, IT and HR support, enabling our teams to focus on delivering exceptional service and care. We are guided by the core values that shape Pennant's unique culture: Customer Second Accountability Passion for Learning Love One Another Intelligent Risk Taking Celebrate Ownership We believe in empowering our people, fostering excellence, and creating an environment where personal and professional growth thrives. Our culture makes Pennant a truly unique place to work. The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at **************************** #onsite The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at ****************************

At Edgewise, we are on a mission to discover new medicines that improve the lives of patients facing serious muscle disease. Our intimate knowledge of muscle biology and biophysics along with our ability to identify and design muscle specific precision small molecules have enabled us to rapidly advance our skeletal muscle and cardiac muscle product candidates into the clinic while also building a robust pre-clinical pipeline. With this focus on therapeutics designed to protect and improve muscle health, our goal is to dramatically enhance the lives of people living with progressive muscle disorders. We have assembled an experienced and highly motivated leadership team with a strong track record in the biotechnology and pharmaceutical industry to build the leading, global muscle disease biopharmaceutical company. Come join us make a significant difference in the lives of patients! About the Position: Edgewise is headquartered in Boulder, Colorado and this is a remote position for a growing Clinical Development team based in and around the east coast. The assigned clinical trials will be highly complex and high risk, e.g., multiple indications, data monitoring committees, interim analyses, adaptive design, requiring the coordination of multiple vendors, or other special assessments. Candidate may be asked to lead/provide oversight for more than one study or across programs and be assigned direct report(s). Essential Job Duties and Functions: Provide operational expertise and strategic input for assigned clinical trials. Provide expertise and operational input into protocol synopsis, final protocol, Informed Consent and other study related documents. Independently creates and manages budgets, forecasting, and monitoring for assigned studies. Oversee country and site feasibility/selection process, with a focus on providing country insights, corporate agreement, and therapeutic expertise to ensure understanding between study execution plan and program strategy. Provide strategic input and management of site activation activities and recruitment strategies. Oversight of study timelines to ensure the needs of the clinical development plan are met. Oversee strategic partners/CRO/vendor selection, budget and contract negotiation, and proper guidance of performance for all activities assigned to a strategic partner/CRO/vendor for assigned studies, including escalation of issues to governance committees when warranted. Approval of essential monitoring documents/plans, periodic review of outputs and actions related to monitoring. Study team meeting management and attendance; regular review of meeting agendas and minutes. Review outcomes/actions related to protocol deviations review; primary purpose of review is to help identify trends across sites or the study. Identify, monitor and review operational risks and decisions at the study level and implementation of mitigation strategies. Oversee site KPIs, protocol deviations and metrics to identify trends and maintain data quality. Escalate site level risks or non-compliance, and in collaboration with Quality Assurance, review Site Corrective and Action Plans (SCAPAs), Corrective and Action Plans (CAPAs) and Site Audits. Maintains cross-functional partnership to test all database timelines and plans; ensure linkage between the strategy (i.e., filing/registration, data generation) with the tactical plan for database lock and CSR. Contributes to drafting Standard Operating Procedures (SOPs) and adheres to Clinical Operations processes and SOPs to ensure studies are "inspection ready" at all times; may be involved in regulatory inspections by preparing for and attending the inspections. Support onboarding, mentor and manage direct reports within the department. May collaborate with other functional leads to manage project related efforts. Participates in departmental quality or process improvement initiatives. Read, understand, and comply with all workplace health and safety policies; safe work practices; and company policies and procedures. Perform other duties as assigned by supervisor. Required Education, Experience and Skills: Bachelor's Degree (Life Sciences) At least 8+ years of relevant clinical operations experience in clinical trial design and conduct, with minimum of 6 years at a biotech or pharmaceutical company. Experience must include Phase 2 and 3 studies (globally recruited). Experience in more than one therapeutic area is advantageous. Pediatric experience is a plus. Experience working with various CRO partnership models, including FSP, and full-service arrangements is preferred. In-depth knowledge of clinical research operations, including GCP, FDA and/or EMEA regulations, and ICH guidelines. Excellence in project management and communication. Travel Requirements: Up to 10-20% travel, including potential to meet as a department in and around New England and to Boulder, Colorado or to clinical sites and conferences. Salary range: $140,000 - $195,000, title and salary commensurate with experience Our Benefits: We are proud to offer health benefits, a discretionary bonus plan, stock option grants. a stock purchase plan, a 401(k) with match and paid time off to our team members as part of their compensation plan. There is no deadline because the employer accepts applications on an ongoing basis. Edgewise does not accept resumes from recruitment agencies for this position. Please do not send resumes to Edgewise employees or the company location. Edgewise is not responsible for any fees related to unsolicited resumes.

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly to communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes a Difference The Director of Clinical Research Operations provides leadership and oversight for all clinical staff supporting brick-and-mortar research sites, mobile/pop-up sites, and hybrid clinical trial models. This role ensures high-quality study execution, regulatory compliance, and strong clinical performance across a geographically dispersed workforce, including traveling CRCs and mobile clinical teams. How You'll Make An Impact Clinical Operations Management Oversight for traveling clinical staff supporting decentralized operations at events and sites. Ensure high-quality protocol execution, participant safety, and adherence to GCP and FDA regulations. Oversee clinical workflows at sites and mobile deployments, resolving issues impacting quality, recruitment, or compliance. People Management Manage, develop, and evaluate all clinical research staff (CRCs, nurses, mobile clinicians, and traveling staff). Implement training, competency standards, and performance expectations for all clinical staff. Provide input into staffing budgets, resource planning, and clinical support models. Study Management Monitor enrollment, data quality, documentation practices, and clinical performance metrics. Partner with regulatory, medical, data, participant experience, and site operations teams to support successful trial delivery. Drive continuous improvement in clinical quality, consistency, and operational efficiency. The Expertise Required Strong knowledge of ICH-GCP, FDA regulations, and clinical trial execution. Excellent leadership, communication, and performance-management skills. Ability to thrive in dynamic environments and manage diverse clinical teams. Certifications/Licenses, Education, and Experience Bachelor's degree in a health-related field required; advanced degree preferred. 12+ years of clinical research operations experience, including leadership of multisite or dispersed clinical teams Experience overseeing CRCs, nurses, mobile clinicians, or traveling clinical staff. How We Work Together Location: Remote within the United States. This role requires 100% of work to be performed in a remote office environment. Travel: This role requires up to 20-40% travel requirements further explained below. Length of travel will depend upon study requirements, staff needs, and company initiatives. Type of Travel Required: National Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. The expected base salary range for this role is $120,000 - $160,000 USD per year. In addition to base salary, this role is eligible for an annual discretionary bonus as part of its overall cash compensation. Benefits & Perks (US Full Time Employees) Paid Time Off (PTO) and Company Paid Holidays 100% Employer paid medical, dental, and vision insurance plan options Health Savings Account and Flexible Spending Accounts Bi-weekly HSA employer contribution Company paid Short-Term Disability and Long-Term Disability 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: The Director, Clinical Operations, will provide strategic leadership and oversight of the Clinical Documentation team's workflow, ensuring operational excellence, financial performance, and client satisfaction. Reporting to the Senior Director, the Director will develop and execute initiatives to optimize processes, enhance productivity, and drive continuous improvement. This role is responsible for high-level planning, resource management, performance monitoring, and cross-functional collaboration to support business objectives and maintain the highest quality standards. The Director will also serve as a key liaison between internal teams and external stakeholders to ensure alignment with company goals and client needs. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. Role & Responsibilities: Serve as the primary liaison for assigned client accounts, fostering strong, trust-based relationships through consistent communication and proactive engagement. Lead strategic client meetings, including business reviews, performance updates, and planning sessions, ensuring alignment with client goals and expectations. Develop and maintain a deep understanding of client needs, business models, and strategic priorities to tailor services and solutions effectively. Drive meeting agendas and outcomes, ensuring discussions are focused, actionable, and aligned with both client and organizational objectives. Coordinate cross-functional collaboration to prepare for client meetings, ensuring all stakeholders are aligned and equipped with relevant data and insights. Report directly to the Senior Director of Clinical Documentation and provide strategic direction for the Clinical Documentation team. Lead, mentor, and develop Clinical Operations managers and team members to foster professional growth and performance excellence. Establish and implement best practices, policies, and procedures to enhance team efficiency and effectiveness. Oversee operational and financial performance, ensuring alignment with organizational objectives and client expectations. Drive innovation and process improvement to enhance departmental effectiveness and market competitiveness. Manage and optimize workflow operations, ensuring smooth execution of daily production schedules, financial goals, and quality standards. Identify operational gaps and implement corrective actions to mitigate risks and improve outcomes. Ensure regulatory compliance and adherence to industry standards across all clinical documentation functions. Oversee performance improvement programs, leveraging data-driven insights to enhance productivity and quality. Develop and present executive-level reports to clients, senior leadership, tracking key performance indicators (KPIs) and operational trends. Utilize data analytics tools (e.g., Power BI, Excel) to interpret and communicate business insights that drive informed decision-making. Ensure timely and accurate reporting of departmental performance, financial goals, and operational strategies. Serve as the primary point of contact for client escalations, ensuring prompt resolution and service excellence. Foster strong relationships with internal and external stakeholders, including clients, revenue cycle teams, and IT support. Partner with cross-functional teams to drive initiatives related to revenue cycle optimization, technology enhancements, and process automation. Oversee training and development programs to ensure team competency and alignment with evolving industry trends. Collaborate with compliance, IT, and finance departments to ensure seamless operations and adherence to corporate policies. Knowledge, Skills & Abilities: AHIMA or AAPC accreditation preferred. Minimum of five years' experience in Revenue Cycle Management. Six Sigma or related LEAN/OPEX/Process Excellence experience desirable. Strong analytical skills with expertise in Microsoft Excel, Power BI, and other data visualization tools. Strong verbal and written communication skills. Ability to work independently, exercise good judgment, and make confident decisions. Proficiency in generating, interpreting, and analyzing reports. Effective team player with the ability to collaborate and communicate effectively across departments. Travel up to 20% may be required for client meetings, team leadership engagements, site visits, and industry events. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

The Company Dexcom Corporation (NASDAQ DXCM) is a pioneer and global leader in continuous glucose monitoring (CGM). Dexcom began as a small company with a big dream: To forever change how diabetes is managed. To unlock information and insights that drive better health outcomes. Here we are 25 years later, having pioneered an industry. And we're just getting started. We are broadening our vision beyond diabetes to empower people to take control of health. That means personalized, actionable insights aimed at solving important health challenges. To continue what we've started: Improving human health. We are driven by thousands of ambitious, passionate people worldwide who are willing to fight like warriors to earn the trust of our customers by listening, serving with integrity, thinking big, and being dependable. We've already changed millions of lives and we're ready to change millions more. Our future ambition is to become a leading consumer health technology company while continuing to develop solutions for serious health conditions. We'll get there by constantly reinventing unique biosensing-technology experiences. Though we've come a long way from our small company days, our dreams are bigger than ever. The opportunity to improve health on a global scale stands before us. Meet the team: Our Global Clinical Program Management team leads Dexcom's worldwide clinical portfolio with a focus on strategic execution, scientific rigor, and seamless collaboration across functions and regions. We design and deliver complex, multi‑region clinical programs that not only navigate diverse regulatory pathways but also generate the robust evidence needed to support market access, reimbursement, and adoption across North America, Europe, APAC, LATAM, and emerging markets. As a key member of this organization, the Sr. Staff Clinical Program Manager helps translate product strategy into actionable global clinical plans-guiding cross‑functional teams through study design, site and country strategy, execution, and ongoing evidence generation. This role thrives in a fast‑paced, international environment and contributes to a culture built on innovation, operational excellence, and the development of high‑performing, globally fluent clinical leaders. Where you come in: Serve as the clinical program leader for one or more global, cross‑functional core teams-translating product strategy into executable clinical program plans and ensuring alignment with broader technical, regulatory, and business objectives. Define and drive the clinical program roadmap, including strategy, requirements, milestones, and interdependencies across multiple complex studies. Lead global study teams through all phases of execution-from early design and feasibility through study close‑out-ensuring scientific rigor, operational excellence, and compliance with worldwide Good Clinical Practice (GCP), ISO 14155, and other regional regulatory requirements. Interface at a senior level with Executive Management, R&D, Regulatory Affairs, Quality, Operations, Marketing, and external partners/CROs to ensure technical and operational integration across program components. Operationalize global clinical strategies, including study design approaches, regulatory evidence pathways, and site/country selection strategies informed by regional regulatory landscapes. Oversee and manage complex program budgets, financial forecasting, and global resource allocation, ensuring optimal use of internal/external resources. Establish and monitor KPIs for clinical execution, proactively identifying risks to study startup, enrollment, data quality, regulatory compliance, and program timelines-and driving mitigation strategies across global teams. Lead vendor strategy and governance, including CRO and specialized vendor selection, contract oversight, performance management, and escalation resolution for multi‑region programs. Implement innovative operational models and tools to optimize efficiency, quality, and scalability of global clinical execution (e.g., digital trial capabilities, centralized monitoring approaches, risk‑based quality management). Represent the clinical program externally, providing senior‑level engagement with investigators, global KOLs, regulatory bodies (as appropriate), and other external stakeholders to ensure alignment on scientific and regulatory expectations. Ensure integration of clinical insights into product development, partnering closely with R&D and technical program management teams to translate clinical outcomes into product improvements and future evidence needs. What makes you successful: You have a strong regulatory knowledge, including Good Clinical Practices (GCPs) and ISO 14155. You have experience with protocol, ICF, CRF development. You have experience with global clinical study planning and execution in the medical device industry. You have experience serving as a Clinical representative on a product development core team. You have exceptional organizational skills and ability to deal with competing priorities, also strong reasoning and problem-solving ability. You have excellent communication (written and verbal) and presentation skills along with leadership qualities. You have strong interpersonal skills and ability to work effectively on cross-functional & global teams. You thrive in an extremely fast-paced environment. Optional/nice to have: Successful experience managing outside CRO groups in Class II/III, preferably diabetes, device studies Proficient with MS Office Suite (Excel, Word and PowerPoint), MS Project, and Smartsheet What you'll get: A front row seat to life changing CGM technology. Learn about our brave #dexcomwarriors community. A full and comprehensive benefits program. Growth opportunities on a global scale. Access to career development through in-house learning programs and/or qualified tuition reimbursement. An exciting and innovative, industry-leading organization committed to our employees, customers, and the communities we serve. Travel Required: 5-15% Experience and Education Requirements: Typically requires a Bachelor's degree in a technical discipline, and a minimum of 13+ years related experience or a Master's degree and 8+ years equivalent industry experience of a PhD and 5+ years of experience Remote Workplace: Your location will be a home office; you are not required to live within commuting distance of your assigned Dexcom site (typically 75 miles/120km). If you reside within commuting distance of a Dexcom site (typically 75 miles/120km) a hybrid working environment may be available. Ask about our Flex workplace option. Please note: The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time. The duties and responsibilities in this job description may be subject to change at any time due to reasonable accommodation or other reasons. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, or protected veteran status and will not be discriminated against on the basis of disability. Dexcom's AAP may be viewed upon request by contacting Talent Acquisition at ****************************. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact Dexcom Talent Acquisition at ****************************. Meritain, an Aetna Company, creates and publishes the Machine-Readable Files on behalf of Dexcom. To link to the Machine-Readable Files, please click on the URL provided: ***************************************************** Code=MERITAIN_I&brand Code=MERITAINOVER/machine-readable-transparency-in-coverage?reporting EntityType=TPA_19874&lock=true To all Staffing and Recruiting Agencies: Our Careers Site is only for individuals seeking a job at Dexcom. Only authorized staffing and recruiting agencies may use this site or to submit profiles, applications or resumes on specific requisitions. Dexcom does not accept unsolicited resumes or applications from agencies. Please do not forward resumes to the Talent Acquisition team, Dexcom employees or any other company location. Dexcom is not responsible for any fees related to unsolicited resumes/applications. Salary: $135,100.00 - $225,100.00

ABOUT THE COMPANY Tembo Health is a virtual medical practice that helps patients in nursing homes receive care in hard to access specialties like psychiatry and cardiology. Our mission is to improve healthcare outcomes. The status quo is unacceptable, as our seniors have difficulty receiving specialty care leading to worse healthcare outcomes including re-hospitalizations. By partnering with nursing homes, Tembo Health drives quality improvement with our network of world-class clinicians. Our technology allows our clinicians to provide both complex and quality care with a seamless user experience integrating medical data from various sources. Our leadership team has deep expertise in clinical medicine, clinical transformation, operations, and technology with experience at top institutions including BCG, GE, Harvard Hospitals, Mount Sinai, Northwell Health, and Oscar. We're backed by prominent investors including Bloomberg Beta, B Capital Group, and Resolute Ventures. We've proven product market fit over the past two years, have customer traction in NY, TX, and MI, and are scaling upon our success. In other words, it's a great time to get in on the ground floor! ABOUT THE ROLE We're looking for a Practice Manager to assist us with our growing clinical team. Responsibilities. Manage day-to-day clinical operations. You'll be asked to coordinate and execute all non-clinical aspects of patient care, starting with patient registration through appointment note sharing through claim followup/ Implement and refine billing and credentialing You'll contract with the major payor and enroll new providers. You'll submit claims, research superior billing methods, and more. Develop tools that improve the work of all team members. You'll leverage Athena, Google Suite and other tools to directly build tools that will help the team with things like tracking project progress. You'll also lend your insight to the Engineering team to build tools for clinicians and others within our EMR. Sample Work Plan With in the first week, you'll own and manage day-to-day clinical operations with activities like patient registration preauthorizations claim submission claim followup Within the first month, you'll have used your experience to get us working more efficiently than most offices with activities like cleaning up our billing processes instituting a plan for credentialing Within first three months, you'll use your management skills make sure our operations can serve our quickly scaling company through activities like owning contracting and onboarding processes for providers owning onboarding processes for facilities Within 6 months, you'll use you problem solving skills and innovation develop best in class procedures across the company implement high levels of automation within the EMR serve as subject matter expert with Engineering team to build tools for the clinical and account management teams ABOUT YOU Qualifications. You'll be successful in this role if You know the Athena EMR You strive to make things efficient You love the challenge of figuring out something new You're not afraid to pick up the phone You keep great notes You've worked in or managed a medical practice or similar Suggested Requirements. The following experiences are suggested but not required: You've worked on large or growing teams Experience with national provider contracts

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 ****************************** 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. Serve as the primary program manager for Epic clinical tools for our PACE program (e.g., assessments, care plans, day center management), coordinating enhancements, upgrades, and cross-functional initiatives Design, implement, and continuously improve intake, prioritization, and tracking mechanisms for clinical tool projects, enhancements, and ongoing maintenance Build and drive a robust program for clinical tools: roadmap planning, status reporting, risk management, and dependency tracking Translate ambiguous clinical and operational needs into clear project scope, requirements, and execution plans Partner closely with PACE Center leadership, Office of the CMO, Population Health, Practice Operations, Finance, Strategy, Growth, and Health Plan Operations to understand priorities and align work accordingly Facilitate working sessions and decision forums with both senior leadership and frontline staff, ensuring clarity, alignment, and forward momentum and identify and fill gaps in end-user trainings Drive refinement of documentation and facilitate demos or training sessions to support adoption and workflow optimization Support limited Salesforce-related initiatives tied to growth, referral workflows, or operational visibility, partnering closely with internal Platform and Data teams Coordinate with Epic, Salesforce, and other third-party vendors to drive timely delivery, clarify system capabilities, and ensure appropriate documentation is collected and shared Qualifications 7+ years of experience managing cross-functional technology or clinical application programs, ideally in healthcare Hands-on experience working with Epic clinical applications (e.g., Ambulatory); familiarity with how clinical workflows operate within Epic Strong ability to bring structure to ambiguity, define scope, and create executable plans from evolving business needs Excellent communication and facilitation skills, with comfort engaging both executive leadership and frontline users Strong documentation skills, including project plans, process flows, and executive-level summaries Proficiency with Microsoft Office tools (Excel, PowerPoint) and visualization tools (e.g., Lucid, Visio) Nice to Have Experience with Salesforce Experience with Agile methodology including leading SCRUM PACE, Medicare/Medicaid, or highly regulated healthcare environments 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 $117,000 -$130,000 and is bonus eligible. 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. 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: *******************************

About Us We're building the technology and clinical services platform to make preventive, connected healthcare accessible for everyone in the US. We deliver hybrid care (in-home + virtual) backed by data products across 15+ states, serving 60%+ of the US population through major health plans and systems. With 1M+ patients and 92+ NPS, we're rapidly scaling our impact. Our team of technologists, clinicians, and operators is backed by investors including a16z, General Catalyst, GV, and Accel that have funded companies like Devoted Health, Livongo, Benchling, Stripe, Ramp, Airbnb, Lyft, Instagram, and Databricks. We have a rapidly growing team of visionary leaders who are passionate about increasing access to care, lowering healthcare costs, and improving outcomes for patients. About The Role We're rapidly growing our clinical team as we cultivate new partnerships with enterprises across the healthcare spectrum. We're looking for an experienced Registered Nurse (RN) to work as a Clinical Manager to oversee our west coast region as well as future markets in the nation as we continue to expand. This role will report to the Director of In Home Care and you will collaborate closely with all Clinical Managers and internal stakeholders to effectively lead the charge of the Sprinters in your assigned regions. The ideal candidate will be an experienced leader with demonstrated ability to effectively manage teams, identify and create solutions. Clinical Operations Management Oversee the daily operations of the clinical field team, ensuring smooth workflow. Develop and implement policies and procedures to maintain high standards of care. Monitor patient care quality, ensuring adherence to clinical guidelines and best practices. Staff Supervision & Development Recruit, train, and manage the clinical Sprinter team. Conduct performance evaluations and provide ongoing coaching and support. Compliance & Quality Assurance Ensure compliance with healthcare regulations (OSHA, HIPAA, Joint Commission, etc.). Monitor incident reports and implement corrective actions as needed. Lead quality improvement initiatives to enhance patient safety and service delivery. Financial & Resource Management Control expenses, and allocate resources effectively. Optimize clinical workflows to improve efficiency and reduce costs. Patient Care Coordination Address patient concerns and ensure a patient-centered approach to care. Respond to abnormal labs, tests, vitals- assess, triage patients to ensure proper follow up care is received. Implement strategies to improve patient satisfaction and outcomes. Collaboration & Communication Work closely with the Clinical Manager team and cross functional teams to ensure Sprinters are supported in the field and all teams are aligned. Attend management meetings and provide updates on clinical operations for your market. You will thrive at Sprinter Health if you have: The desire to work collaboratively with a tight-knit but quickly growing team across many different areas of the business Flexibility, humility, and a sense of humor Excitement for working in a fast-paced startup Experience and Skills 5+ years of Registered Nurse experience Experience in a healthcare startup or virtual management experience preferred Direct report management experience Proficient at working with modern technology Able to do extensive travel of up to 50% This position will be a hybrid role where you will work some days from home and others travel to various coverage regions to meet $110,000 - $140,000 a year The base salary range for this full-time position is $110,000 - $140,000 + benefits. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Sprinter Health is an equal opportunity employer. We 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, disability status or other protected classes. If you're looking for a career that offers opportunities for growth, continual development, professional challenge and the chance to make a real difference in the lives of people, apply today! Beware of recruitment fraud and scams that involve fictitious job descriptions followed by false job offers. If you are applying for a job, you can confirm the legitimacy of a job posting by viewing current open roles here. All legitimate job postings will require an application to be made directly on our official Sprinter Health Careers website. Job-related communications will only be sent from email addresses ending **********************. Please ensure that you're only replying to emails that end ************************.

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 Senior Clinical Program Manager (Sr. 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 Sr. 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 3-5 years clinical trial management experience; IDE trial experience REQUIRED. Minimum of 8 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

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.

Leads the alignment, standardization and ongoing improvement of ministry length of stay for designated patient populations. Serves as designated ministry liaison with providers and ministry Care Coordination teams, to move patients towards safe and effective discharge plans or transitions to the most appropriate next level of care. Plans and develops reporting tools for sharing of information between division and ministry teams. Providence caregivers are not simply valued - they're invaluable. Join our team at St. Jude Medical Center and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: + Associate's Degree - Nursing. + Bachelor's Degree - Nursing. + California Registered Nurse License upon hire. Preferred Qualifications: + 5 years - Experience as a utilization/case manager in an acute care setting. + Experience in a multi-hospital and/or integrated healthcare system. Why Join Providence ? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 410203 Company: Providence Jobs Job Category: Clinical Administration Job Function: Clinical Support Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7510 SJMC CASE MGMT Address: CA Fullerton 101 E Valencia Mesa Dr Work Location: St Jude Medical Center Workplace Type: Remote Pay Range: $67.93 - $107.26 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

The International Rescue Committee (IRC) responds to the world's worst humanitarian crises, helping to restore health, safety, education, economic wellbeing, and power to people devastated by conflict and disaster. Founded in 1933 at the call of Albert Einstein, the IRC is one of the world's largest international humanitarian non-governmental organizations (INGO), at work in more than 40 countries and 29 U.S. cities helping people to survive, reclaim control of their future and strengthen their communities. A force for humanity, IRC employees deliver lasting impact by restoring safety, dignity and hope to millions. If you're a solutions-driven, passionate change-maker, come join us in positively impacting the lives of millions of people world-wide for a better future. The IRC's Home Study and Post-Release Services (HSPRS) for unaccompanied children in the U.S. is a national, multi-million-dollar project with ambitious delivery goals in a short time frame. The goals of the Home-Study Post Release Services Program (HS/PRS) are to: - Assess the safety and suitability of a sponsor before an unaccompanied child is released from custody into a sponsor's care (Home Study) - Provide case management support via remote and / or conducting in-home visits to ensure the continued safety and stability of children in sponsor's homes and linking children to resources in the community (Post Release Services). The HSPRS Clinical Program Manager (CPM) provides a combination of capacity building, staff supervision, and supervision of complex cases to IRC's Home Study and Post-Release Services (HSPRS) programming, as well as provides support to other emergent issues related to Unaccompanied Children's protection in the U.S. This role provides clinical supervision to between four and eight Master Level intensive case managers who are providing case management services to Unaccompanied Children enrolled in HSPRS services throughout the United States. The CPM will help ensure that services and supports that are delivered to unaccompanied minors in HSPRS services are done in alignment with trauma-informed and developmentally appropriate best practices. The position will act as a point of escalation for complex or crisis cases and provide coaching and consultation to help ensure that they are resolved with the safest possible outcomes. The CPM is also expected to advance frameworks, guidance, training materials, manuals and other resources in alignment with federal, state, local and donor requirements and IRC global guidelines. Major Responsibilities: • Supervise 4-8 Masters-level case managers that provide direct services to highly vulnerable unaccompanied children. • Help support onboarding and provide regular training and other professional development opportunities in critical competencies like child development considerations, trauma informed care principles, crisis management, etc. • Provide staff consultation and coaching to increase the capacity of staff to deliver trauma-informed, developmentally appropriate, and culturally responsive services while supporting staff in the management of cases that require expert level clinical skills. • Support HSPRS staff in liaising with complex systems (i.e., child welfare, law enforcement, mental health, etc.). • Assist HSPRS staff as needed in appropriate internal and external mental health and crisis intervention resources and provide oversight of crisis intervention and advise on clinical needs and related referrals. • Provide point of escalation for clinical questions to ensure that services are ethical and aligned with best practices. • Ensure that the IRC's HSPRS efforts align with established professional treatment standards and practices. • Support staff in staying resilient by reinforcing positive work practices and self-care strategies, including facilitating connections to Duty of Care resources as appropriate. • Provide direct input and support to local supervisors on the recruitment, onboarding, training and performance management of HSPRS Intensive Case Managers. • Liaise regularly with direct supervisors of field-based HSPRS staff on program progress. • Other duties as assigned. Job Requirements: • Must have a Masters degree in social work, psychology, sociology or other relevant behavioral science in which clinical experience is a program requirement, plus at least two years of post-graduate direct services experience, Clinical licensure preferred. • Must have HSPRS experience. • At least five years of experience managing complex cases with vulnerable populations, ideally with children and adolescents, within the context of foster care, guardianship, or kinship care. • At least two years of experience working with refugee, immigrant, migrant or other forcibly displaced communities. • Demonstrated experience supervising staff, interns or volunteers. Clinical supervisors must have prior supervisory experience and should be licensed to provide clinical supervision, so long as supervising PRS conducted across state lines does not violate state licensing rules. • Strong understanding of child development, trauma-informed care, responsive service delivery, and strength-based and client-centered services. • Demonstrated experience in case management and helping vulnerable individuals and families navigate complex systems and connect to resources. • Experienced with competently managing emergent, urgent and crisis situations with clients (i.e., child welfare, suicidal ideation, mental health concerns, etc.) • Highly developed interpersonal skills including active listening, emotional de-escalation, patience, and compassion. • Service-oriented leadership skills. • Strong analytic problem-solving skills. • Fluency in English, written and spoken. Fluency in Spanish a significant plus. • Ability to work both independently and in a dynamic, cross-functional global team structure. • Ability to manage and work through change in a proactive and positive manner. • Must be cleared and approved by Office of Refugee Resettlement and background check including FBI fingerprints and Child Abuse and Neglect checks required upon hire (initiated by IRC after acceptance of the position). Working Environment • Remote Work. Up to 20% travel required. Compensation: (Pay Range: $77,343 - $90,203.28) Posted pay ranges apply to US-based candidates. Ranges are based on various factors including the labor market, job type, internal equity, and budget. Exact offers are calibrated by work location, individual candidate experience and skills relative to the defined job requirements. PROFESSIONAL STANDARDS All International Rescue Committee workers must adhere to the core values and principles outlined in IRC Way - Standards for Professional Conduct. Our Standards are Integrity, Service, Equality and Accountability. In accordance with these values, the IRC operates and enforces policies on Safeguarding, Conflicts of Interest, Fiscal Integrity, and Reporting Wrongdoing and Protection from Retaliation. IRC is committed to take all necessary preventive measures and create an environment where people feel safe, and to take all necessary actions and corrective measures when harm occurs. IRC builds teams of professionals who promote critical reflection, power sharing, debate, and objectivity to deliver the best possible services to our clients. Cookies: *********************************************** Compensation: Posted pay ranges apply to US-based candidates. Ranges are based on various factors including the labor market, job type, internal equity, and budget. Exact offers are calibrated by work location, individual candidate experience and skills relative to the defined job requirements. US Benefits: We offer a comprehensive and highly competitive set of benefits. In the US, these include: 10 sick days, 10 US holidays, 20-25 paid time off days depending on role and tenure, medical insurance starting at $163 per month, dental starting at $6.50 per month, and vision starting at $5 per month, FSA for healthcare and commuter costs, a 403b retirement savings plans with immediately vested matching, disability & life insurance, and an Employee Assistance Program which is available to our staff and their families to support counseling and care in times of crisis and mental health struggles. Equal Opportunity Employer: IRC is an Equal Opportunity Employer. IRC considers all applicants on the basis of merit without regard to race, sex, color, national origin, religion, sexual orientation, age, marital status, veteran status, disability or any other characteristic protected by applicable law. #li-1

The Clinical Consulting Manager (PRN) provides expert clinical consulting and utilization management support on an as‑needed basis. This role partners with internal leadership, utilization management teams, and clients to deliver interim management support, clinical operational guidance, and subject‑matter expertise. Responsibilities Key Responsibilities Provide PRN clinical consulting and interim management support for assigned projects or clients Apply advanced Utilization Management (UM) expertise to support episode management, care coordination, and clinical operations Collaborate with clinical leaders and cross‑functional stakeholders to assess needs and implement recommendations Serve as a clinical subject‑matter expert supporting performance improvement and operational initiatives Participate in meetings, reviews, and consultative sessions aligned with project scope Adjust work hours as needed to support clients operating in different time zones Maintain compliance with applicable clinical, regulatory, and organizational standards Qualifications Required Associate's Degree in nursing, social work, physical therapy or another related discipline Active and unrestricted license in related field At least 5 years of progressive clinical management experience At least 2 years quality assurance and/or case management experience In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word Excellent written and verbal communication and presentation skills are required Preferred Bachelor of Science in nursing (BSN), social work, physical therapy or another related discipline Expectations Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Position may at times require extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones Travel up to 25% as needed Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.

About Us: Affinity Hospice is one of the fastest growing, privately held hospice organizations in the country. We are passionate about giving exceptional care to our hospice patients and their families. We believe the care we provide truly matters and we would love to have you join our nationally recognized team! What We Offer: · Paid Time Off (PTO), Sick Time, and Holiday Pay · Gas Card Program and Car Maintenance Stipend · Benefit Package (Medical, Dental, Vision and more) for full-time employees · 401K · Employee Assistance Program · Tuition Reimbursement for eligible employees · Internal Company Advancement · Free end of life training Position Summary: The Area Executive Clinical Manager ensures coordinated, high-quality patient care across all branches within their assigned region. This role oversees clinical operations, ensuring services meet regulatory and quality standards, while providing leadership, guidance, and support to Clinical staff. Acting as the regional counterpart to a Clinical Manager, this position also serves as interim clinical leadership at branch locations during Clinical Manager vacancies. The position requires extensive travel (approximately 90%) and the ability to sit in branch locations as needed to ensure operational stability, compliance, and continuity of leadership Minimum Qualifications: EDUCATION: Associate's degree in nursing from an accredited college or university required; bachelor's degree preferred Graduate of a National League for Nursing (NLN) accredited school of nursing; BSN preferred EXPIERENCE: Minimum of two (2) years of management or supervisory experience in a hospice or home care setting Proven ability to work effectively within an interdisciplinary team Experience supporting multiple locations or regional operations preferred CERTIFICATION/LICENSURE: Active and unencumbered Registered Nurse (RN) license required Clinically licensed in states within assigned region preferred Current CPR certification Valid driver's license with an insured and operational automobile in accordance with state and/or organization requirements Key Responsibilities: Review case referrals and assess patient needs across assigned branches, including conducting home visits as needed Assign appropriate hospice associates and collaborate with Medical Directors to determine eligibility for services Oversee and evaluate patient cases through home visits, conferences, and record reviews across the region Provide guidance and support to clinicians to improve performance and service delivery Review patients' medical diagnoses, prognoses, medications, procedures, and clinical courses Assist clinicians in establishing goals, setting priorities, and developing effective care plans Lead and support case conferences to ensure care coordination and interdisciplinary collaboration Conduct record reviews and provide findings and recommendations to Executive Directors and clinical staff Serve as interim Clinical Manager by sitting in branch locations when positions are vacant Participate in the hiring, screening, orientation, and training of clinical associates and leadership staff Assist in planning, implementing, and evaluating in-service and continuing education programs Support policy and procedure development and ensure compliance with professional standards and principles Participate in quality assessment and performance improvement initiatives across the region Perform other duties as delegated by leadership knowledge, skills, and abilities required Strong knowledge of hospice and home care clinical practices and regulatory requirements Ability to coordinate, oversee, and evaluate patient care delivery across multiple locations Strong clinical judgment, problem-solving, and decision-making skills Ability to manage multiple priorities and adapt quickly in new environments Effective verbal and written communication skills Strong leadership, coaching, and mentoring abilities Willingness and ability to travel extensively (approximately 90%) Commitment to ethical practice, confidentiality, and quality patient care Affinity Hospice is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

At Labcorp, we believe in the power of science to change lives. We are a leading global life sciences company that delivers answers for crucial health questions. Through our unparalleled diagnostics and drug development capabilities, we provide insights and accelerate innovations that not only empower patients and providers but help medical, biotech, and pharmaceutical companies transform ideas into innovations. Central Laboratory Services is part of a global contract research organization within Labcorp. We offer the world's largest network of central laboratories and support global clinical trials testing. A common set of processes, procedures, and instrumentation is offered throughout our sites in Europe, Asia/Pacific, and the United States, allowing us to receive samples globally and provide more than 700 assays across all laboratory science disciplines. LabCorp is seeking an **Associate Director, Global Client Delivery,** to join our **Central Labs Services** team. In this position, you will be accountable to create, implement and advance the Study Management function's vision and strategy in alignment with the Global Project Management (PM) strategy. This position is directly responsible for the day-to-day management and supervision of the study management team to ensure the successful implementation of the global project management strategy, structure, process, and metrics to deliver outstanding customer satisfaction. The Associate Director will ensure integrated services with other global parts of Global Project Management, across departments and business units, focusing on innovative solutions to meet the needs of the pharmaceutical and biotech industries. The three primary areas of focus are: + People: Provide an environment where people can build their careers and thrive + Process: Contribute to an ongoing and sustainable improvement in cost, quality and service delivery for the Portfolio Manager, GSM and SDL functions. + Client: Deliver market-leading quality in an environment of increased regulatory scrutiny through a systematic quality program with focus on continuous improvement. **This is a remote opportunity and can be located anywhere in the US. Indianapolis metro area preferred.** **Responsibilities:** + Manage and supervise the day-to-day operations of the project management team including but not limited to: + Ensure the development of a competent workforce to meet growth plans within budget. + Ensure the seamless integration of project management services and influence pan-Labcorp Drug Development as necessary. + Accountable for the activities and outcomes of the project management team(s), taking corrective action where appropriate. + Ensure appropriate resource allocation to successfully implement and execute project plans to achieve agreed upon service levels. + Ensure consistent implementation, use, and review of SOPs. + Establish and monitor performance objectives for direct reports and take corrective action where appropriate. + Complete thorough, timely and well-documented performance evaluations and interim progress reviews. + Lead the study management team tasks related to planning, budgeting, and cross project management team issues. + Participate in the Project and Alliance Leadership team to establish strategy and business plans. + Engage in mentoring and developing staff and participate in Talent Assessment and Succession Planning processes. + Champion the PM Excellence strategy to continue to grow and enhance the PM competencies across the organization. Engage and partner with other PM pan-Labcorp Drug Development to share best practices and develop appropriate partnerships. + Drive a culture of continuous improvement, quality, and productivity. + Identify business growth opportunities and project management service enhancements. Monitor, track, and manage progress to the PM strategy. Share learning and best practices as appropriate. + Ensure all service failures and opportunities (CCLS and pan-Labcorp Drug Development) are identified, tracked, and resolved in a timely manner. Take preventative action to ensure that the same service failure(s) does not occur. Share learning and best practices as appropriate. + Accountable for the effective management of the study management team budget as appropriate. + Effectively partner and influence across CLS Leadership, Alliance Leaders, Business Development Directors, and Executive Sponsors to meet the growing and evolving client needs. **Minimum Experience Required:** + Minimum 5 years of people leadership experience + Experience managing a team of up to 20 plus is preferred + Excellent written, verbal, and interpersonal skills + Demonstrated high degree of initiative and ability to work collaboratively + Proven ability to inspire effective teamwork and motivate staff in a multi-regional, matrixed environment + Knowledge of regulatory requirements in clinical or laboratory settings + Strong negotiation skills to facilitate, guide, and influence a unified approach within a global, cross-functional environment + Proven strength in planning, problem solving, and organization + Consistent track record of driving continuous improvement and achieving results through leadership + Demonstrated ability to interact with, influence and inspire staff at all levels of the organization + Inclusive and engaging presentation and communication skills + Demonstrated leadership development capabilities **Minimum Education/Qualifications/Certifications and Licenses Required:** + 4-year degree + Clinical trial or central laboratory experience in a people leadership role + Regulatory experience (GXP) **Preferred Education:** + MBA or master's degree **Application Window:** closes at the end of the day 1/30/2026 **Pay Range:** 130-160K per annum All job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data. The position is also eligible for an annual bonus under the Labcorp Bonus Plan. Bonuses are payable based on corporate and/or business segment performance and are subject to individual performance modifiers. **Benefits:** Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here (************************************************************** . **Labcorp is proud to be an Equal Opportunity Employer:** Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law. **We encourage all to apply** If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site (**************************************************** or contact us at Labcorp Accessibility. (Disability_*****************) For more information about how we collect and store your personal data, please see our Privacy Statement (************************************************* .

Ready to Elevate Addiction Recovery? If you're looking to redefine the way care is delivered and be at the forefront of addiction recovery, we have the career for you! Your expertise and compassion can change lives-one virtual session at a time Gateway Rehab Center (GRC) is seeking a passionate and skilled Clinical Manager to revolutionize the way we deliver care. This management position allows you to bring compassion, innovation, and expertise to individuals on their journey to recovery-all from the comfort of your home with occasional travel to a GRC location. If you're driven by the mission of making high-quality, accessible care a reality for all, we want to hear from you! Please Note: This is a remote position with occasional travel to a GRC facility in Robinson, PA. Ideal candidate should live in the Pittsburgh area or surrounding counties. Why Choose Gateway Rehab? Make an impact through Gateway's mission “to help all affected by addictive disease to be healthy in body, mind, and spirit.” Be a part of an organization that has been leading the way in addiction treatment for over 50 years. Leverage cutting-edge telehealth technology to bridge gaps in care and transform lives. Enjoy the flexibility of a remote role while maintaining meaningful client. Why This Role is the Future of Addiction Treatment? GRC's Telehealth Services team is changing lives, and as a Clinical Manager, you'll be at the forefront of this movement. Your work will expand access to critical services, empower clients, and shape the future of addiction recovery. This is more than just a job-it's a mission-driven career where you can make a lasting impact every single day. Your Role in Transforming Recovery Conduct authorization audits to ensure timely completion, avoiding any disruption in payments. Develops a training curriculum for Aura/m.care, tailored for new hires in all Telehealth positions. Performs chart audits for compliance of all new admissions, ensuring deadlines are met and sending reminders to staff with outstanding documentation. Maintains staff training records and identify training opportunities based on areas of need, as recommended by the Director or Executive Director. Oversees patient program attendance, ensuring compliance with policies and licensure requirements, particularly for psych services and IOP. Conducts documentation audits across different levels of care to ensure timely completion of all required items. Attends mandatory GRC trainings and in-services. Requirements What We're Looking For Master's degree in field that meets Pennsylvania Department of Health staffing qualification regulations required. License or certification from the Pennsylvania Certification Board eligible. Two years' clinical experience in a health or human service agency, including one year working directly with chemically dependent persons. Supervisory experience preferred. Knowledge of Substance Use Disorders and Evidence-based treatment methods. Strong leadership skills. Ability to manage crisis, make decisions, and make sound clinical judgements. Excellent written and verbal communication skills. Additional Requirements Pass PA Criminal Background Check. Obtain PA Child Abuse and FBI Fingerprinting Clearances. Pass Drug Screen. TB Test. Work Conditions Remote with travel into a GRC facility. Favorable working conditions. Minimal physical demands. GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

The Commercial team is hiring a Clinical Review Manager to support the Commercial lines of business through BlueCross BlueShield of Tennessee. This role conducts comprehensive clinical reviews of medical service requests using established criteria and supports utilization management activities such as pre‑certifications, appeals, and retrospective reviews. The Clinical Review Nurse applies sound clinical judgment and contractual guidelines to promote appropriate care, collaborates with the Medical Director on escalated cases, facilitates care coordination through referrals, and supports administrative review processes to ensure compliance with clinical standards and policies. If this opportunity aligns with your experience and interests, we encourage you to apply! What We're Looking For (In Addition to Required Qualifications): Preference for candidates who bring: Strong computer comfort and technical aptitude A collaborative, team‑oriented approach Flexibility and adaptability A positive attitude and willingness to learn Typical Schedule Our team primarily follows a Monday-Friday, 8:00-5:00 schedule with some flexibility. Who You'll Work With This role partners mainly with: Providers and facilities who submit prior authorization requests What Your Day‑to‑Day Looks Like Your daily focus includes: Reviewing cases in strict turnaround‑time order Meeting required deadlines on cases Prioritizing urgent or escalated cases as assigned by leadership Ensuring each review is completed accurately, efficiently, and in alignment with clinical and contractual standards 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: BCBST BlueCross BlueShield of Tennessee, 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.