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Clinical supervisor work from home jobs - 569 jobs

  • Clinical Case Manager Behavioral Health - Spanish Speaking - Work at Home

    CVS Health 4.6company rating

    Remote job

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Telephonic clinical case management with Medicare population.Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. Completes a Comprehensive Assessment and Plan of care.Will document in clinical systems to support legacy Aetna and Coventry membership.Provides BH consultation and collaboration with Aetna partners.Active participation in clinical treatment rounds.Active participation in team activities focused on program development. Innovative thinking expected.The majority of time is spent at a desk on telephonic member outreaches and computer documentation.Assist members with locating community based behavioral health resources.Required Qualifications3+ years of direct clinical practice experience An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC, LISW, LSW) Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service Bilingual Spanish and English Preferred QualificationsCrisis intervention skills preferred Managed care/utilization review experience preferred Case management and discharge planning experience preferred Discharge planning experience Utilization review, prior authorization, concurrent review, appeals experience CCM preferred DSNP experience a plus Knowledge of Substance Abuse DisordersEducationMasters Degree in Social Work or Counseling required Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $39k-51k yearly est. 5d ago
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  • Global insurance Clinical Care Manager - Bilingual Japanese RN - Remote

    Unitedhealth Group 4.6company rating

    Remote job

    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities: A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse with an active unrestricted United States license Must be bilingual in Japanese and English, with strong verbal and written communication skills 3+ years of experience in medical-surgical inpatient acute care Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals Proven communication skills at all levels Proven ability to be flexible and display a positive attitude Proven solid problem-solving, organizational and crisis management skills Proven ability to function confidently and efficiently in fast paced work environment Proven ability to foster team cohesion in an international virtual environment Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members Proven advanced software skills with ability to work in multiple platforms with clinical case reviews Proven advanced skills with Microsoft Office - Excel, Word Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed care or hospital environment Experience in international healthcare and/or air medical transport Experience in discharge planning and/or chart review International travel experience Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $72.8k-130k yearly 4d ago
  • Senior Clinical Program Manager

    Histosonics 3.6company rating

    Remote job

    HistoSonics is a medical device company, founded in 2009, that has developed a non-invasive, sonic beam therapy platform that uses histotripsy, which is capable of destroying targeted liver tumors. Our mission and passion are to advance the novel science of histotripsy and its powerful benefits, bringing meaningful and transformational change to physicians and their patients. Location: Remote position, ideally candidates will live in a major metro area with an international airport. Travel Expectation: Travel (by automobile or air, day trips and overnight stays) up to 25% of the time. Position Summary: The 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
    $68k-107k yearly est. 60d+ ago
  • Program Manager, Clinical Insights

    Wellsense Health Plan

    Remote job

    It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Program Manager, Clinical Insights is responsible for implementing and managing programs designed to improve health outcomes and strengthen financial performance overall and at the product level. Program coordination will take place across multiple clinical stakeholder groups such as care management, utilization management, and quality teams. The Program Manager, Clinical Insights supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate. The position may engage in functions of health information technology development that enhances or maintains activities associated with QI initiatives, accreditation, and monitoring, measuring or reporting clinical effectiveness and outcomes. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · Implement and manage member health promotion programs associated with NCQA Population Health Management standards, and general member health and wellness programs designed to improve health outcomes and reduce inappropriate utilization, including pilots and new program design interventions · Lead performance improvement projects associated with annual Performance Improvement budget and corporate goals, assembling stakeholders to design, execute, and monitor projects · Manage and drive execution on outbound campaigns and selective member outreach, partnering with Care Management teams and Quality · Key point of contact to engage with marketing on overall clinical, member facing information · Support centralization of active member outreach by various teams · Support program monitoring through the use of analytic dashboards and KPIs Supervision Exercised: · None Supervision Received: · General supervision is received weekly. Qualifications: Education: · Bachelor's degree or equivalent combination of education and relevant experience in a health plan setting required Education Preferred/Desirable: · Master's degree in business or health related/public health field preferred Experience: · 3+ years of healthcare/managed care experience · 3+ years in program management, healthcare operations, or other applicable work experience · Managed care experience in NCQA accreditation, care management, population health, or quality programs Certification or Conditions of Employment: · Successful completion of pre-employment background check Competencies, Skills, and Attributes: · Exceptional written and oral communication skills. · Excellent organizational skills and attention to detail · Demonstrated ability to work independently and manage multiple complex projects simultaneously · Proactive, motivated, and a collaborative team player · Demonstrated ability to adapt quickly to changing priorities · Strong critical thinking, analytical, and problem-solving skills · Proficiency with MS tools including Word, Excel, PowerPoint, Visio and MS Project · Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives. Working Conditions and Physical Effort: · Able to perform all work from a remote environment · Occasional travel may be required · Regular and reliable attendance is an essential function of the position Compensation Range $69,500 - $100,500 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
    $69.5k-100.5k yearly 7d ago
  • Clinical Program Manager - CMS Medical Review (RVC)

    Broadway Ventures 4.2company rating

    Remote job

    At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Location: Remote (U.S.) Schedule: Monday-Friday, 8:00 AM-4:30 PM ET Employment Type: Full-Time Position Overview We are seeking an experienced Program Manager to oversee daily operations for the CMS Review and Validation Contractor (RVC) Program. This role serves as the primary point of contact to the CMS RVC COR and is responsible for ensuring all contract, operational, and medical review requirements are executed in accordance with CMS guidelines. The ideal candidate brings a strong clinical background (RN), extensive Medicare program knowledge, and proven leadership experience managing large, complex healthcare projects. Key Responsibilities Serve as the contractor's authorized representative on all daily operational matters. Maintain ongoing communication with the CMS RVC COR regarding contract performance, staffing, and deliverables. Oversee medical review activities and ensure compliance with CMS guidelines and FFS RAC Program requirements. Lead cross-functional teams and manage staff required to support RVC operations. Ensure accurate interpretation of Medicare coverage, documentation, and regulatory standards. Monitor project progress, performance measures, and quality assurance outputs. Prepare operational updates, reports, and data summaries for CMS and internal leadership. Ensure effective workflows, staffing coverage, and adherence to deadlines and contract terms. Provide clinical oversight and guidance across medical review tasks and methodologies. Required Qualifications 5+ years of Program Management experience overseeing large or complex healthcare projects. Experience in medical review, healthcare auditing, or clinical review operations. Extensive knowledge of the Medicare program, including CMS regulatory and operational requirements. Working knowledge of the CMS FFS RAC Program. Strong leadership abilities with experience managing multidisciplinary teams. Education & Licensure Master's degree in Business, Healthcare Administration, Nursing, Management, or a related healthcare field from an accredited institution. Current, active U.S. Nursing License (RN); must be maintained throughout employment. Preferred Skills Excellent written and verbal communication skills. Strong analytical, organizational, and problem-solving abilities. Experience working with government contracts or federal healthcare programs. Ability to manage multiple projects and deadlines in a fast-paced environment. Why Join Us Opportunity to lead mission-critical work that supports the integrity of the Medicare program. Collaborative team environment with impactful clinical and operational responsibilities. Competitive compensation and benefits package. How to Apply Submit your resume detailing your program management experience, clinical background, and Medicare/CMS expertise. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.
    $62k-96k yearly est. Auto-Apply 48d ago
  • Clinical Program Manager, HSPRS

    Equal Opportunity Employer: IRC

    Remote job

    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
    $77.3k-90.2k yearly Auto-Apply 29d ago
  • Clinical Program Manager RN - REMOTE - Days

    Providence Health & Services 4.2company rating

    Remote job

    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. Providence caregivers are not simply valued - they're invaluable. Join our team at St. Joseph Hospital Of Orange and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: + Associate's Degree in Nursing + Bachelor's Degree in Nursing. Or + Upon hire: California Registered Nurse License. + 3 years Experience in Utilization Management. + Experience working with InterQual and MCG guidelines. Preferred qualifications: + Master's Degree in Nursing. + 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: 410644 Company: Providence Jobs Job Category: Clinical Administration Job Function: Clinical Support Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7540 SJO CASE MGMT Address: CA Orange 1100 W Stewart Dr Work Location: St Joseph Hospital-Orange 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.
    $68k-113k yearly est. Auto-Apply 2d ago
  • Clinical, Manager, Prior Authorization Technician

    Capital Rx 4.1company rating

    Remote job

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

    Psi Cro Ag

    Remote job

    PSI is a leading Contract Research Organization with more than 30 years in the industry, offering a perfect balance between stability and innovation to both clients and employees. We focus on delivering quality and on-time services across a variety of therapeutic indications. Job Description We are looking for an Operating Room (OR) Nurse to join PSI as a Clinical Trial Liaison! In this role, a Clinical Trial Liaison: Acts as a specialized liaison to assist sites with a protocol-tailored approach to increase efficiency of the patient identification and recruitment process Assists sites in developing and implementing patient enrollment techniques Coordinates site specific patient recruitment and retention plans observing the planned metrics Provides information specific to the area of expertise to site team members involved in patient recruitment Identifies, tracks, and reports patient enrollment progress throughout the study Analyses the protocol in order to provide the site with the support needed to improve the patient pathway Provides support to the project teams to ensure proper documentation of study-specific assessments related to patient enrollment Assists and advises the site monitor in the area of patient enrollment This role requires travel. Qualifications Registered Nurse (RN) Degree A minimum of 5 years of experience as an OR Nurse Experience in operation and QC procedures related to the equipment used in the specialized area Additional Information All your information will be kept confidential according to EEO guidelines.
    $50k-87k yearly est. 1d ago
  • Clinical Relations Manager

    Global 4.1company rating

    Remote job

    How will you make an impact? Manages identified Clinical Sites to educate prospective study subjects and health care professionals about clinical trial participation. Takes on added responsibility as requested from VP of Clinical Relations to assist the team in achieving Glaukos clinical enrollment goals. The specific tasks could be: new employee training, planning and leading Glaukos study investigators meetings, planning and implementing scheduled Investigator conference calls, overseeing the creation and delivery of monthly clinical study newsletters, Updating iPad with CRM study tools, performing the functions of CRM while also executing the Surgical Specialist tasks on identified trained Investigators, leading the team with updates with tracking subject software (iMednet), development of tools for scheduling clinical surgery, development of patient out-reach programs, development of surveys to track performance from our customers, attendance as needed to major local, regional, national, international industry meetings, development of surgical forms as needed as technique is developed for new Glaukos products. Being prepared as a back-up to the CRA to deliver the "Excellence in Research" program, Take the lead as directed on developing the system for Glaukos in-office surgery. What will you do? Leads clinical recruitment efforts on key US IDE and post-approval trials. Acts as an integral member of the core project team working directly with the Clinical Affairs team (Directors or Managers of Clinical Affairs, and Clinical Research Associates) and the Surgical Specialists (Regional Business Managers), and any other relevant team members. Develops strong personal relationships with study investigators, clinical coordinators, and glaucoma/cataract key opinion leaders. Establishes and builds rapport with clinical sites and assess their recruitment challenges and opportunities. Based on a thorough assessment, develops a detailed and specific subject recruitment plan for clinical sites participating in Glaukos-sponsored studies. Implements and facilitates subject recruitment and retention activities. Analyzes metrics to identify trends, issues, areas of success and for improvement. Identifies and proposes strategies, procedures, systems, technology etc. to improve productivity and efficiencies in clinical trial subject recruitment. Develops detailed site specific study pre-screening plans based on protocol inclusion/exclusion criteria. Performs and oversees patient chart reviews to identify potential study subjects. Complies with HIPAA, pertinent federal and state laws and regulations, and relevant Glaukos internal procedures. Identifies outreach opportunities to educate patients, health care professionals, advocacy groups, and potential referring physicians about study participation. Monitors referral sources to ensure adequate study information is provided to potential participants. Identifies, coordinates, and staffs appropriate events and meetings, as needed. Proactively and effectively communicates updates on site status to clinical management, Clinical Affairs, and RBMs. Communicates trends in the industry and, whenever possible, status of competitive clinical trials. Determines best practices for working with sites on increasing subject enrollment. Works with other respective Clinical Relations Managers to elevate team success. Attends major ophthalmic meetings, as needed. Provide training to ophthalmology practices on how to properly and efficiently identify patients within their practice who are potential candidates for commercial iStent implantation. Employ effective tools and programs to properly communicate the potential benefits of iStent implantation to appropriately identified patients. How You'll Get there: Minimum 9+ years relevant work experience in the medical device or pharmaceutical industry, preferably with experience in ophthalmology and medical devices. Required Knowledge of medical terminology required, with knowledge of ophthalmology terminology strongly preferred Required Prior experience in business development or as a study coordinator or clinical research assistant desirable Required Prior experience developing and executing training plans Required Knowledge of the medical, scientific, design, and clinical research aspect of medical device and/or pharmaceutical trials Required Strong communication, interpersonal, and analytical skills Required Excellent time management and organizational skills Required Experience in MS Office (Outlook, Word, Excel); familiarity with databases helpful Required Self-motivated and able to work independently, as well as within a team in a multidisciplinary environment Required Must be willing and able to travel a significant amount of time (> 50%) Required Flexibility, as assignments vary in location, time intensity Required Exhibits personal integrity, credibility, and responsibility Required Bachelor's Degree with major in biological science, nursing, or other health-related discipline preferred COA - Certified Ophthalmic Assistant Preferred COT - Certified Ophthalmic Medical Tech Preferred #GKOSUS
    $66k-104k yearly est. Auto-Apply 10d ago
  • Manager, Clinical Operations - Full Service CRA Line Manager (Home-Based in Western US )

    Syneos Health Clinical Lab

    Remote job

    Syneos Health is a leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. We translate unique clinical, medical affairs and commercial insights into outcomes to address modern market realities. Our Clinical Development model brings the customer and the patient to the center of everything that we do. We are continuously looking for ways to simplify and streamline our work to not only make Syneos Health easier to work with, but to make us easier to work for. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to accelerate the delivery of therapies, because we are passionate to change lives. Discover what our 29,000 employees, across 110 countries already know: WORK HERE MATTERS EVERYWHERE Why Syneos Health We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program. We are committed to our Total Self culture - where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people. We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together diversity of thoughts, backgrounds, cultures, and perspectives - we're able to create a place where everyone feels like they belong. Job Responsibilities Core Responsibilities Line management of Clinical Operations staff, responsibilities including interviewing and selection, termination, professional development, performance appraisals, and employee counselling May be involved in assignment of project work and will review workloads for all direct reports. Manages staff by establishing goals that will increase knowledge and skill levels, and by delegating tasks commensurate with skill level. Review workload for all staff in reporting chain, participate in managing the resource availability for the assigned staff, providing support that projects are suitably resourced and staffing needs are identified in a timely fashion. Provide expert operational oversight and guidance to support prioritization of activities, review and monitor the work performed, metric compliance, and development of contingency plans, among others. Assist in recruiting new staff, including participation in interview process and new hire on boarding. Proactively work to ensure staff retention and turnover rates remain within expected levels. Ensure quality and adherence to Standard Operating Procedures/Work Instructions (SOP/WIs) and compliance with federal and local guidelines and ICH GCP. Ensure all staff follow required training and complete required documentation. Provide regular updates to management accordingly. Work closely within appropriate business unit/region to ensure staff performance on studies and correct deficiencies as identified by staff, customers, and auditors. Able to contribute to BU level process improvements. May provide business development support. May conduct several types of sign off and assessment visits to ensure Clinical Operations on-site performance. Develop and oversee training plans to address performance deficiencies. Ensure staff adhere to training guidelines, training records maintenance, and individual and corporate training needs are identified and addressed. Organize and chair clinical staff meetings at regular intervals. Manage issues and provide follow up for action items requiring resolution. Facilitate and support project and team/country reviews with Clinical Operations staff, focusing on budget, schedule, and risk analysis. Use department systems, reports, and dashboards to identify performance issues, process gaps and monitor overall performance progress in line with departmental goals and metric targets. Oversee all quality control efforts of assigned teams. Qualifications Bachelor's degree in life sciences, nursing degree, or equivalent related experience, plus extensive clinical research experience in a contract research organization, pharmaceutical or Biotechnology Company, including some time in a leadership capacity or equivalent combination of education, training and experience is required. Extensive knowledge of GCP/ICH guidelines and other applicable regulatory requirements Excellent communication, presentation, interpersonal, and change management skills, both written and spoken, with an ability to inform, influence, convince, and persuade. Strong time management, technical and organizational skills. Ability to work independently and within a team environment. Knowledge of basic financial concepts as related to forecasting and budgeting. Understands project budgets. Must demonstrate good computer skills and be able to embrace modern technologies. Ability to travel as necessary (up to 25%) At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. *************************** Additional Information Tasks, duties, and responsibilities as listed in this are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job.
    $60k-90k yearly est. Auto-Apply 13d ago
  • Manager, Clinical Operations - Full Service CRA Line Manager (Home-Based in Western US )

    Syneos Health, Inc.

    Remote job

    Syneos Health is a leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. We translate unique clinical, medical affairs and commercial insights into outcomes to address modern market realities. Our Clinical Development model brings the customer and the patient to the center of everything that we do. We are continuously looking for ways to simplify and streamline our work to not only make Syneos Health easier to work with, but to make us easier to work for. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to accelerate the delivery of therapies, because we are passionate to change lives. Discover what our 29,000 employees, across 110 countries already know: WORK HERE MATTERS EVERYWHERE Why Syneos Health * We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program. * We are committed to our Total Self culture - where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people. * We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together diversity of thoughts, backgrounds, cultures, and perspectives - we're able to create a place where everyone feels like they belong. Job Responsibilities Core Responsibilities * Line management of Clinical Operations staff, responsibilities including interviewing and selection, termination, professional development, performance appraisals, and employee counselling May be involved in assignment of project work and will review workloads for all direct reports. Manages staff by establishing goals that will increase knowledge and skill levels, and by delegating tasks commensurate with skill level. * Review workload for all staff in reporting chain, participate in managing the resource availability for the assigned staff, providing support that projects are suitably resourced and staffing needs are identified in a timely fashion. * Provide expert operational oversight and guidance to support prioritization of activities, review and monitor the work performed, metric compliance, and development of contingency plans, among others. * Assist in recruiting new staff, including participation in interview process and new hire on boarding. Proactively work to ensure staff retention and turnover rates remain within expected levels. * Ensure quality and adherence to Standard Operating Procedures/Work Instructions (SOP/WIs) and compliance with federal and local guidelines and ICH GCP. Ensure all staff follow required training and complete required documentation. Provide regular updates to management accordingly. * Work closely within appropriate business unit/region to ensure staff performance on studies and correct deficiencies as identified by staff, customers, and auditors. Able to contribute to BU level process improvements. May provide business development support. * May conduct several types of sign off and assessment visits to ensure Clinical Operations on-site performance. Develop and oversee training plans to address performance deficiencies. Ensure staff adhere to training guidelines, training records maintenance, and individual and corporate training needs are identified and addressed. * Organize and chair clinical staff meetings at regular intervals. Manage issues and provide follow up for action items requiring resolution. * Facilitate and support project and team/country reviews with Clinical Operations staff, focusing on budget, schedule, and risk analysis. Use department systems, reports, and dashboards to identify performance issues, process gaps and monitor overall performance progress in line with departmental goals and metric targets. Oversee all quality control efforts of assigned teams. Qualifications * Bachelor's degree in life sciences, nursing degree, or equivalent related experience, plus extensive clinical research experience in a contract research organization, pharmaceutical or Biotechnology Company, including some time in a leadership capacity or equivalent combination of education, training and experience is required. * Extensive knowledge of GCP/ICH guidelines and other applicable regulatory requirements * Excellent communication, presentation, interpersonal, and change management skills, both written and spoken, with an ability to inform, influence, convince, and persuade. * Strong time management, technical and organizational skills. Ability to work independently and within a team environment. * Knowledge of basic financial concepts as related to forecasting and budgeting. Understands project budgets. * Must demonstrate good computer skills and be able to embrace modern technologies. * Ability to travel as necessary (up to 25%) At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. *************************** Additional Information Tasks, duties, and responsibilities as listed in this are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job. Summary Accountable for and provides management support and direct supervision to Clinical Operations staff in the assigned areas including Site Selection support, site contracts support, regulatory/ethics submissions, site activities including site activation as well as On-Site Monitoring and/or Central Monitoring through Study Close Out. Provides training, consultation and oversees metric compliance and quality related to operating activities of assigned staff to ensure project deliverables are met. Collaborates and oversees Clinical Operations Team to ensure fulfillment of customer requirements and compliance with related regulations. Supports senior management in operational level planning. May participate in business development presentations as a subject matter expert in Clinical Operations functions within the Company.
    $60k-97k yearly est. 12d ago
  • Clinical Review Coordinator

    Soleo Health 3.9company rating

    Remote job

    Full-time Description Soleo Health is seeking a Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA) . Join us in Simplifying Complex Care! Must be able to work 8:30am-5pm Eastern Time Zone Monday-Friday. Soleo Health Perks: Competitive Wages Flexible schedules 401(k) with a match Referral Bonus Paid Time Off Annual Merit Based Increases No Weekends or Holidays Affordable Medical, Dental, and Vision Insurance Plans Company Paid Disability and Basic Life Insurance HSA and FSA (including dependent care) options Education Assistant Program The Position: The Clinical Review Coordinator works closely with all departments to research and provide accurate and timely clinical review on complex, patient cases to ensure that approval is secured and to mitigate risk of technical and clinical denials. The Clinical Review Coordinator attempts to resolve denials by utilizing nationally recognized criteria for appeal submission. Responsibilities include: Completes prior authorization reviews in a timely manner through their clinical expertise evaluating patient clinicals and payer clinical criteria to determine if the service meets medical necessity of the payer Reviews and comprehends patient progress notes, lab reports, infusion summaries, imaging reports, and plan of care. Identifies appropriate medical documentation that satisfies payer medical policy criteria. Request additional clinical information when needed to render a decision and/or determine next steps Assists with creation of clinical support packets to be used for the initial prior authorization and/or subsequent appeals In cases of authorization denials, constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Creates and maintains, a library of clinical support resources to include templates for appeals, journal articles, other reference tools that can be used to support medical necessity. When existing resources are unavailable search for supporting clinical evidence to support appeals. Provides program support by staying current on the top payer covered services, medical necessity requirements and formulary details. Also, must be proficient in locating payer resources related to medical policies. Assist with post service insurance denials & appeals Participates in outcome programs including but not limited to data entry, reporting functions, and patient calls with necessary to complete denial support tasks Provides inter-departmental training to increase teams' knowledge for top disease states and specialty drugs, clinical requirements, and prior authorization & appeal best practices Schedule: Must be able to work Remote, 8:30am-5pm Eastern Time Zone Monday-Friday Must have experience with denial support, clinical reviews, and appeals for Infusions Requirements Bachelor's degree in healthcare field or 3 years in a qualified position Preferred experience with patients with specialty infusion needs and challenges Excellent communication skills (written, oral, and presentation), excellent customer service and interpersonal skills Flexible communication style, highly motivated team player with excellent listening skills Able to handle stress to meet identified program objectives and manages time effectively Self-starter that takes responsibility, is comfortable with accountability and results oriented Competent in the use of Word, Excel, and Power Point Must be able to communicate effectively with all levels of organization within Soleo Health. Must enthusiastically support Soleo Health's philosophy and goals. About Us:Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference! Soleo's Core Values: Improve patients' lives every day Be passionate in everything you do Encourage unlimited ideas and creative thinking Make decisions as if you own the company Do the right thing Have fun! Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture. Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor. Keywords: Now Hiring, Hiring Now, Immediately Hiring, Hiring Immediately, Clinical Review Coordinator, Infusion Clinical Review Coordinator, Patient Access, Patient Access Clinical Review Coordinator, Denial Support Clinical Review Coordinator, Appeals Clinical Review Coordinator, Home Infusion, Specialty Infusion Salary Description $68,000 - $85,000 per year
    $68k-85k yearly 4d ago
  • Pharmacy Clinical Coordinator (Temporary 9 months)

    Careoregon 4.5company rating

    Remote job

    --------------------------------------------------------------- This position is responsible for assisting with the management of the pharmacy benefit and developing and delivering clinical and educational interventions designed to improve pharmaceutical use. Responsibilities include formulary management; assisting with management of specific patients in the multidisciplinary case management/medication therapy management program, P&T, developing and conducting educational initiatives to improve prescribing patterns; develop and conduct quality improvement programs related to the pharmacy program; evaluating medication authorization requests and providing oversight to the medication PA process; and other pharmacy program activities as assigned. NOTE: This is a temporary position expected to last 9 months. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee. Critically evaluate drug therapy regimens for patients enrolled in the case management program and assist with developing treatment plans. Provide medication therapy management services. Develop and conduct retrospective drug use reviews. Review medication prior authorization requests and appeals. Develop and implement clinical educational programs to improve drug utilization and quality. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others. Develop and conduct quality improvement programs related to the pharmacy program. Monitor functions provided by the plans' Pharmacy Benefit Manager including pharmacy benefit coding, customer service guidelines, prior authorization activities, and other delegated services. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Assess, review, and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Review and refine pharmaceutical reimbursement and purchasing procedures. Develop materials to communicate pharmacy benefit or other information to members, clinicians, and pharmacists. Experience and/or Education Required Graduate of an accredited pharmacy program Current, unrestricted license as a pharmacist in Oregon Advanced pharmacy training (PharmD, residency, fellowship, or master's degree in related discipline) Practical experience as a clinical pharmacist in formulary management or ambulatory care or other clinical setting Preferred Previous experience in managed care Experience with reviewing Prior Authorization requests against plan criteria and making approval or decline decisions Knowledge, Skills and Abilities Required Knowledge Must have comprehensive, clinical pharmaceutical knowledge base Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift and carry for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
    $48k-62k yearly est. Auto-Apply 5d ago
  • Customer Experience Clinical Coordinator

    Solace 4.1company rating

    Remote job

    Solace is a healthcare advocacy marketplace that connects patients and families to experts who help them understand and take charge of their personal health About The Role As a Clinical Operations Coordinator, you will play a critical role in ensuring seamless day-to-day operations for our growing telehealth provider workforce. You will provide real-time operational support to physicians, proactively manage schedules across 1099 and W2 providers, and serve as a key liaison between providers, patients, and internal teams when unexpected issues arise. This role is highly dynamic and requires someone who thrives in fast-paced, real-time problem solving. From responding immediately when a visit runs long, to coordinating coverage during physician call-outs or technical disruptions, you will help ensure continuity of care, fairness in scheduling, and a positive experience for both patients and physicians. You will also help track and evaluate provider utilization, no-show rates, and pilot scheduling initiatives (including evenings and weekends), providing insight that supports operational excellence and sustainable growth. About Solace Healthcare in the U.S. is fundamentally broken. The system is so complex that 88% of U.S. adults do not have the health literacy necessary to navigate it without help. Solace cuts through the red tape of healthcare by pairing patients with expert advocates and giving them the tools to make better decisions-and get better outcomes. We're a Series B startup, founded in 2022 and backed by Inspired Capital, Craft Ventures, Torch Capital, Menlo Ventures, and Signalfire. Our fully remote U.S. team is lean, mission-driven, and growing quickly. Solace isn't a place to coast. We're here to redefine healthcare-and that demands urgency, precision, and heart. If you're looking to stretch yourself, sharpen your edge, and do the best work of your life alongside a team that cares deeply, you're in the right place. We're intense, and we like it that way. Read more in our Wall Street Journal funding announcement here . What You'll Do Provide real-time operational support to providers when immediate outreach is needed (i.e., rescheduling visits, contacting patients or family members) Act as a central point of coordination with the Medical Director during provider call-outs, technical issues, or when visits extend beyond scheduled time Manage and optimize schedules for a mixed workforce of 1099 and W2 physicians to ensure consistent staffing during peak demand Proactively contact and support impacted patients when scheduling changes or delays occur Monitor and help ensure fairness and consistency in leave usage, flagging outliers or concerns to leadership Ensure provider calendars accurately reflect approved availability, identifying and escalating unapproved or anomalous blocks Support pilot scheduling initiatives (evenings, weekends, extended hours) by tracking utilization, no-show rates, and provider participation Maintain clear documentation and communicate operational issues, trends, and recommendations to leadership Collaborate closely with clinical, operations, and technical teams to resolve issues quickly and effectively Take on other operational duties as assigned in support of a growing telehealth organization What You Bring To The Table Strong organizational skills and the ability to manage multiple real-time priorities without losing attention to detail Comfort working in a fast-paced, provider-facing environment where quick decisions matter Excellent communication skills, especially in high-pressure or time-sensitive situations Experience with scheduling, staffing coordination, or workforce management (healthcare or telehealth experience strongly preferred) Ability to work confidently with both providers and patients, maintaining professionalism and empathy Data-aware mindset: comfortable tracking metrics such as utilization, no-shows, and coverage gaps Proactive problem solver who anticipates issues and takes ownership of solutions High degree of reliability, discretion, and sound judgment Flexibility to support coverage during extended hours or weekends as pilots are launched A team-first attitude with a “get it done” mentality Applicants must be based in the United States. Up for the Challenge? We look forward to meeting you. Fraudulent Recruitment Advisory: Solace Health will NEVER request bank details or offer employment without an interview. All legitimate communications come from official solace.health emails only or ashbyhq.com. Report suspicious activity to recruiting@solace.health or advocate@solace.health.
    $48k-67k yearly est. Auto-Apply 17d ago
  • Mental Health Therapist with Sign-on Bonus!

    Bethany for Children & Families 3.3company rating

    Remote job

    (Outpatient Mental Health Therapists will work with our team at Bridgeview Community Mental Health Center in Clinton, Iowa.) Are you looking for a therapy role where your clinical skills are valued, your time is respected, and your work truly makes a difference? At Bridgeview Community Mental Health Center, you'll join a supportive, mission-driven team that prioritizes quality care, professional growth, and work-life balance while serving a community that genuinely needs you. Bethany for Children & Families is expanding our team at Bridgeview Community Mental Health Center and is seeking multiple passionate, caring, and motivated Outpatient Mental Health Therapists to join us. WHY YOU'LL LOVE THIS ROLE! - Start your weekends early with Friday afternoons OFF! Schedule: Monday - Thursday (9-hour shifts), Friday (4-hour shift) This role offers the option to work remotely one day per week. - AI scribe support to assist with documentation, helping you to save valuable time and reduce paperwork! - Strong benefits AND supervision support, including: · Vacation time that grows with you earn up to 80 hours your first year, and up to 160 hours after your first year · Sick time you can count on earn up to 96 hours each year · 11 paid holidays every year · 403(b) retirement plan with 8% employer contribution (no match required) · Choice of two health plans (one with an HSA + employer contributions) · Dental insurance · Vision insurance (100% employer-paid) · Group Life and AD&D insurance (100% employer-paid) · Options for extra voluntary coverage · Educational Aid program to support your professional growth - Meaningful community impact without overwhelming caseloads! - Sign-on bonuses available: · $1,500 Sign-on Bonus for Independently Licensed Clinicians (LMSW or tLMHC) · $1,000 Sign-on Bonus for initially Licensed Clinicians (LMSW or tLMHC) - Competitive salary based upon licensure and experience · Average salary of $65,000.00, based on experience and Therapist Level 1 or Level 2 (see requirements below) OUR VISION Bridgeview Community Mental Health Center is a comprehensive, community and clinic-based provider committed to supporting the mental health and well-being of individuals and families in our service area. We strive to anticipate and respond to changing needs while delivering the highest quality of care. With the support of our communities, we pledge to provide services with compassion, excellence, and accountability. Our organization provides a wide range of services to support children, families, and individuals in need. We offer clinic-based services, school-based therapy, and community-based programs designed to meet clients where they are and provide the care they deserve. To learn more about who we are and the impact we make, visit our website! *********************** Every day, we strive to create brighter futures for those we serve. Were searching for team members who share that passion and are ready to contribute their skills in a supportive, balanced environment. OUTPATIENT MENTAL HEALTH THERAPIST AT A GLANCE Flexible & Responsive Care · Adapt your schedule to meet program and client needs. · Opportunity to earn extra money ($200.00 per week) by providing after-hours on-call coverage. Clinical Expertise · Conduct mental health evaluations to determine medical necessity and diagnosis. · Develop, implement, and monitor individualized treatment plans. · Deliver evidence-based therapeutic interventions tailored to client needs. · Ensure informed consent and proper completion of legal/agency documentation. · Complete discharge planning and summaries. Collaboration & Coordination · Partner with families, schools, hospitals, case managers, and community resources. · Ensure continuity of care and manage transitions effectively. · Provide training and consultation to staff and colleagues when needed. Documentation & Compliance · Maintain accurate clinical records, reports, and required data in a timely manner. · Follow all agency policies, as well as all legal, licensing, and accreditation requirements. · Uphold the highest standards of ethics, integrity, and professional practice. Professional Growth · Participate in ongoing training and staff development. · Receive consistent, supportive clinical supervision focused on growth, confidence, and licensure success. Ready to Make a Difference? If you are looking for a place where your work matters, your time is respected, and your growth is supported, we would love to meet you! Apply today and become part of a therapy team thats changing lives while growing together and making a lasting impact in our community. Requirements: Requirements for an Outpatient Mental Health Therapist: Licensing & Driving Requirements · Valid drivers license with the ability to operate agency vehicles. · Acceptable auto insurance coverage. Education & Licensure · Therapist I o Masters degree in a mental health field (psychology, counseling, psychiatric nursing, social work, etc.). o Current, unrestricted initial license (tLMHC, LMSW, LPC, LSW) in Iowa or Illinois, depending on work location. · Therapist II o Masters degree in a mental health field (psychology, counseling, psychiatric nursing, social work, etc.). o Current, unrestricted independent license (LISW, LMHC, LCPC, LCSW) in Iowa or Illinois, depending on work location. Experience & Skills · Proficiency with MS Word, Excel, and ability to learn other software. · Ability to physically attend to children in moments of difficulty. Bethany for Children & Families is an Equal Opportunity Employer. Were committed to diversity and creating a welcoming environment for all backgrounds and identities. PI5ad8c639b868-31181-38472009
    $65k yearly 8d ago
  • Charge Capture Coordinator - Clinical Revenue Integrity - Full Time 8 Hour Days (REMOTE) (Non-Exempt) (Non-Union)

    Usc 4.3company rating

    Remote job

    Under the general direction of the Revenue Manager, the Charge Capture Coordinator is primarily responsible for unit and area specific charge capture of clinical services and procedures within revenue producing departments throughout the system. The Charge Capture Coordinator's main role is to enter charges into existing computerized billing system (Cerner and or PBAR). The Charge Capture Coordinator will perform due diligence in entering all appropriate charges accurately and within a timely manner, including conducting reconciliation of department generated record with billing system report to ensure optimal charge capture; auditing for completeness, correcting, and resubmitting rejected charges and charge follow-up. The Charge Capture Coordinator is also responsible for communicating missing or incomplete clinical documentation and charge entry errors for clinical department process improvement. Essential Duties: Review department clinical documentation from multiple sources and enter hospital charges accurately, timely and in accordance with Keck Medical Center of USC charge capture policies/guidelines, into Patient Accounting System -Cerner or PBAR. . Demonstrate proficiency in using Keck Medical Center of USC charge capture policies, rules, criteria and decision trees (algorithms) to assign the correct charge code. Demonstrate understanding of CMS Medicare billing rules, regulations, and compliance related to outpatient intravenous infusion and chemotherapy administration charges, observation charging (and other service line charges.) Perform daily charge reconciliation on accounts; check charges for accuracy and completeness, correct errors. Follow processes to send appropriate notification to other parties such as Coding Manager, Clinical Department Manager, or Patient Accounting Manager. For example, notify the nursing team of incomplete medical records or coding questions. Attend scheduled meetings and trainings and be accountable for what has been discussed in staff meetings. Identify events requiring administrative review and forward these promptly to the appropriate Revenue Cycle Supervisor, Manager or Director. Review own work for accuracy and completeness prior to end of shift. Daily focus on attaining productivity standards, recommending new approaches for enhancing performance, and productivity when appropriate. Identify and alert a member of the management staff of any situation that may negatively impact the patient, department operations, public relations, or the hospital's integrity. Adhere to health information regulations including HIPAA. Perform other duties as assigned. Required Qualifications: Req High school or equivalent Req 2 years Clinical or healthcare disciplines such as previous hospital or medical office, charge entry or medical records experience. Req Must have excellent data entry and quality outcome skills Req Proficient in Microsoft Office applications and others as needed Req Communicates clearly and concisely, verbally and in writing Req Demonstrates knowledge and understanding of organizational policies, procedures and systems Req Must have the ability to maintain confidentiality of patient, physician and health system information Req Strong interpersonal, teamwork and customer service skills are necessary Req Ability to maintain minimum standards of productivity and accuracy Req Strong analytical skills Req Understanding and/or experience computerized billing systems. Req Current knowledge of medical terminology, anatomy, and physiology. Req Basic coding knowledge Preferred Qualifications: Pref Related undergraduate study Related college or trade school coursework Pref 1 year Experience with advanced education degree/certification Pref Knowledge of legal and fiscal requirements in the healthcare industry. Required Licenses/Certifications: Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) Pref Certified Coding Specialist - CCS (AHIMA) or CPC from AAPC or related HFMA, AHIMA certification The hourly rate range for this position is $29.00 - $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at **************, or by email at *************. Inquiries will be treated as confidential to the extent permitted by law. Notice of Non-discrimination Employment Equity Read USC's Clery Act Annual Security Report USC is a smoke-free environment Digital Accessibility If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser: *************************************************************
    $29-45.2 hourly Auto-Apply 35d ago
  • Behavioral Health Clinical Review Manager

    Bluecross Blueshield of Tennessee 4.7company rating

    Remote job

    Are you passionate about making a meaningful impact on the lives of individuals facing mental health challenges, while working behind the scenes? If so, Utilization Management might be the perfect fit for you! In this role, you'll play a critical part in shaping care decisions and improving outcomes, all without direct, face-to-face interaction. What You'll Do Apply your knowledge of Behavioral Health and Withdrawal Management diagnoses. Navigate the continuum of care and levels of care for Behavioral Health and Withdrawal Management. Present cases confidently and effectively during clinical rounds. Work independently with minimal supervision. Excel in a fast-paced, dynamic environment. Our Ideal Candidates will have an RN or Social Work license and: 3 years - Clinical behavioral health / substance use disorder experience required 1 year - Must be knowledgeable about community care resources and levels of behavioral health care available. Along with: 3+ years of experience in Psychiatric and/or Substance Use treatment. Background in Behavioral Health settings (both inpatient and outpatient). Prior experience in Utilization Management or Managed Care. Strong communication and presentation skills. Ability to work autonomously and manage time effectively. Adaptability and resilience in a rapidly changing work environment. Why Choose Us? This is more than a job; it's an opportunity to make a lasting difference in people's lives while leveraging your expertise in a collaborative, supportive setting. Job Responsibilities Assists non-clinical staff in performance of administrative reviews Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. 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. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications License Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical behavioral health / substance use disorder experience required Skills\Certifications Must be knowledgeable about community care resources and levels of behavioral health care available. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Independent, Sound decision-making and problem-solving skills Excellent oral and written communication skills Strong interpersonal and organizational skills Strong analytical skills Positive relationship building skills and ability to engage with diverse populations Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions 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.
    $83k-98k yearly est. Auto-Apply 6d ago
  • Clinical Trial Intern

    Vial

    Remote job

    Who We Are Vial is a hyper-scalable biotech company advancing programs into the clinic by leveraging dramatically cheaper trials and computationally designed therapeutics. Our mission is to reimagine drug development in order to cure all human diseases. We have assembled a talented team of clinical operators, chemists, and innovative thinkers to achieve this vision. Vial is fully remote and was founded by Simon Burns in October 2020. Since our founding, we have grown rapidly to a team of 50+ employees with over $100 million in funding from leading investors including General Catalyst, Box Group, and Byers Capital. Vial is rebuilding the infrastructure to advance research. By deploying technology at every step, we are creating a more efficient future for drug discovery. Why You'll Love Working At Vial Innate curiosity. At our core, we embody an insatiable curiosity. Our journey into the realm of clinical trials was ignited by a firsthand understanding of the challenges involved. This innate curiosity drives us to constantly innovate, seek fresh ideas, and bring our vision of reimagining clinical trials to life. Fostering autonomy. Autonomy is our guiding principle. We firmly believe that when team members are entrusted with autonomy, they unleash their true potential. Our culture fosters an environment where each individual takes ownership of their domain, empowering them to make a profound impact. The pursuit of mastery. We are dedicated to cultivating mastery. We understand the value of honing expertise in a craft. The pursuit of mastery, coupled with a deep sense of pride in one's workmanship, fuels our unwavering commitment to tackle intricate challenges. At Vial, we foster a culture of highly autonomous professionals, each an expert in their field, collaborating on an immensely demanding endeavor together. Move fast, stay humble. Our strength lies in agility and humility. We firmly believe that intellectual honesty and a nimble mindset are the pillars of success. By staying adaptable and open-minded to all solutions, we tackle obstacles head-on, remaining humble in the face of adversity. This enables us to surmount the hurdles that confront us at every twist and turn. What You'll Do Support the Clinical Development team in planning and execution of early-stage clinical trials. You'll gain exposure to protocol development, trial operations, and the systems that keep studies running smoothly. Key Responsibilities * Assist with preparation and review of trial documents (protocols, informed consent forms, study reports) * Track study timelines, milestones, and deliverables * Help organize and maintain clinical trial data, regulatory submissions, and correspondence * Support coordination with sites, CROs, and internal stakeholders * Contribute to process improvement projects within clinical operations What You Will Bring * Strong organizational skills and attention to detail * Interest in clinical research, drug development, or healthcare operations * Ability to manage multiple tasks and prioritize effectively * Strong written and verbal communication skills Preferred Skills * Background in life sciences, public health, or related field * Familiarity with clinical trial design or regulatory environment (FDA, ICH/GCP) * Experience with project management tools (Notion, Excel, or similar) * Previous internship or coursework in clinical research a plus
    $29k-43k yearly est. 60d+ ago
  • Clinical Pharmacology and Pharmacometrics Intern Summer 2026

    8427-Janssen Cilag Manufacturing Legal Entity

    Remote job

    At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at ******************* Job Function: Career Programs Job Sub Function: Non-LDP Intern/Co-Op Job Category: Career Program All Job Posting Locations: Cambridge, Massachusetts, United States of America, La Jolla, California, United States of America, Raritan, New Jersey, United States of America, Spring House, Pennsylvania, United States of America, Titusville, New Jersey, United States of America Job Description: Johnson & Johnson Innovative Medicine is recruiting for multiple Clinical Pharmacology and Pharmacometrics summer interns at its US (Spring House PA, Raritan NJ, Titusville NJ, Cambridge MA and La Jolla CA) sites. Clinical Pharmacology and Pharmacometrics (CPP) is an integrated part of the Global Development organization within Johnson & Johnson Innovative Medicine. Members of CPP work in cross-disciplinary compound development teams and apply Clinical Pharmacology principles and pharmacometrics methodologies across the R&D portfolio to enable optimal decision-making in drug development. The CPP Summer Internship Program provides a unique opportunity for students passionate about drug development to collaborate with clinical pharmacologists and pharmacometricians and gain hands-on experience in CPP principles, including pharmacokinetics/pharmacodynamics (PK/PD), translational modeling, and model-informed drug development (MIDD) within a dynamic pharmaceutical R&D environment. Our teams leverage students' academic backgrounds while fostering their professional development, providing firsthand experience in drug development and an opportunity to evaluate the student's potential for future employment. CPP summer interns will contribute to diverse Research and Development efforts spanning preclinical to early- and late-stage clinical development, through activities such as: Clinical Pharmacology and Medical literature review Data analysis of PK, biomarker, preclinical and/or clinical data, trial design, etc. PK and PD model-building and analyses Development of computer programs or state-of-the-art quantitative methodologies (e.g., population PK/PD, quantitative systems pharmacology [QSP]) Model based meta-analysis (MBMA), advanced data visualization (e.g., RShiny), and machine learning applications integrating publicly reported and in-house data Therapeutic areas of immunology, oncology, neuroscience, cardiopulmonary and metabolic diseases Qualifications Candidates must be enrolled in an accredited college or university (not necessarily taking classes) pursuing a MS, PharmD, PhD, MD or similar degree in a life sciences-related discipline such as Pharmacology, Pharmacometrics, Pharmaceutical Sciences, Molecular or Computational biology, Biophysics, Biostatistics, Mathematics, Engineering, or Medicine. Candidates should demonstrate computational proficiency, including experience with data analysis, modeling, and simulation tools such as NONMEM, Phoenix WinNonlin, Monolix, R, Python, or MATLAB. Candidates must be available to work full-time for at least 12 weeks between May - September 2026. Candidates must be detail-oriented, highly organized, and capable of managing multiple tasks efficiently. Candidates must have strong communication and presentation skills. Candidates must have the ability to work independently as well as collaboratively within a team. Candidates must be eligible to work in the US for the entirety of their internship period and will be required to provide proof of work authorization. Remote work flexibility may be available. Housing stipend will be available. Permanently authorized to work in the U.S., must not require sponsorship of an employment visa (e.g., H-1B or green card) at the time of application or in the future. Students currently on CPT, OPT, or STEM OPT usually requires future sponsorship for long term employment and do not meet the requirements for this program unless eligible for an alternative long-term status that does not require company sponsorship. Johnson & Johnson is 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, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act. Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants' needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via *******************/contact-us/careers . internal employees contact AskGS to be directed to your accommodation resource. Required Skills: Preferred Skills: The anticipated base pay range for this position is : $23.00/hr to $51.50/hr Additional Description for Pay Transparency: The expected pay range for this position is between $23.00 per hour and $51.50 per hour but will be based on candidate's program year, discipline, degree and/or experience. Co-Ops/Interns are eligible to participate in Company sponsored employee medical benefits in accordance with the terms of the plan. Co-Ops and Interns are eligible for the following sick time benefits: up to 40 hours per calendar year; for employees who reside in the State of Washington, up to 56 hours per calendar year. Co-Ops and Interns are eligible to participate in the Company's consolidated retirement plan (pension). For additional general information on Company benefits, please go to: ********************************************* This job posting is anticipated to close on 09/11/2026. The Company may however extend this time-period, in which case the posting will remain available on *************************** to accept additional applications.
    $25k-41k yearly est. Auto-Apply 15d ago

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