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Nursing director work from home jobs

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  • Medical and Health Services Managers

    Mercor

    Remote job

    ## **About the Role** Mercor is seeking experienced **medical and health services managers** to support a leading AI lab in advancing research and infrastructure for next-generation machine learning systems. This engagement focuses on diagnosing and solving real issues in your domain. It's an opportunity to contribute your expertise to cutting-edge AI research while working independently and remotely on your own schedule. ## **Key Responsibilities** - You'll be asked to create deliverables regarding common requests regarding your professional domain - You'll be asked to review peer developed deliverables to improve AI research ## **Ideal Qualifications** - 4+ years professional experience in your respective domain - Excellent written communication with strong grammar and spelling skills ## **More About the Opportunity** - Fully remote and asynchronous - complete work on your own schedule - Expected workload: 30 hours per week, with flexibility to scale up to 40 hours - Project start date: immediately, lasting for around 3-4 weeks ## **Compensation & Contract Terms** - Independent contractor engagement through Mercor - Hourly compensation, paid weekly via Stripe Connect - Payments based on services rendered; contractors maintain full control over their work schedule and methods . **About Mercor** - Mercor is a talent marketplace that connects top experts with leading AI labs and research organizations - Our investors include Benchmark, General Catalyst, Adam D'Angelo, Larry Summers, and Jack Dorsey - Thousands of professionals across domains like engineering, research, law, and creative services have partnered with Mercor on frontier AI projects We consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request. ## **Earn $250 by referring** Share the referral link below, and earn $250 for each successful referral through this unique link. There's no limit on how many people you can refer. Restrictions may apply. [Learn
    $67k-102k yearly est. 42d ago
  • Lead Care Manager (LCM)

    Heritage Health Network 3.9company rating

    Remote job

    The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.
    $36k-47k yearly est. 1d ago
  • Director, Clinical Operations

    Alma International 4.4company rating

    Remote job

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

    Accredo Health 4.8company rating

    Remote job

    Home Infusion Registered Nurse - Accredo Specialty Pharmacy Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: Active RN license in the state where you'll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver's license Willingness to travel to patients' homes within a large geographic region Ability to work 40 hours a week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
    $85k-104k yearly est. Auto-Apply 60d+ ago
  • Associate Director, Clinical Operations, Therapeutics and Oncology

    Moderna Theraputics

    Remote job

    The Role: Moderna is seeking an Associate Director of Clinical Operations, Therapeutics and Oncology to manage studies within the Oncology Therapeutic Area. This may include more than one study. This position will be responsible for initiating and leading clinical trials across all phases, including overseeing CROs and vendors and working cross-functionally on clinical operations strategy and related initiatives. This position will work collaboratively across the therapeutic area and cross-functional teams on the overall development programs and related studies to ensure successful execution of assigned projects. Here's What You'll Do: * Accountable for delivery of assigned clinical study budget, timelines, and resource management with focus on quality, including making recommendations and decisions regarding operational strategies to support study and/or program objectives * Develop operational strategy and clinical operations plans in support of execution of the Clinical Development Plan * Partner and collaborate with cross-functional stakeholders such as the Project Leader, Clinical Lead and other relevant stakeholders * Lead and oversee execution of first-in-human through phase 4 trials, depending on lifecycle of program, in compliance with ICH/GCP, local regulations, and Moderna SOPs * Manage invoice and budget tracking for individual studies and provide input into budget forecasting activities * Support the selection, oversight, and management of CROs and other vendors * Oversee site feasibility/capability assessments in collaboration with the CRO and cross-functional team * Review and provide clinical operations input into relevant clinical documents such as the protocol, investigator brochure, regulatory documents, clinical study reports and other documents and plans as appropriate * Manage the cross functional team and CRO/vendor(s) related to all aspects of clinical trial operations * Responsible for representing Clinical Operations on cross-functional project teams and vendor/CRO operational meetings and ensuring compliance with operational standards and procedures * Along with other Clinical Development personnel, represent Moderna externally to Investigators, site staff, and Key Opinion Leaders * Perform and document study level Sponsor Oversight of outsourced clinical activities * Communicate study-status, cost and issues to ensure timely decision-making by senior management * Manage invoice and budget tracking for individual studies and provide input into monthly and annual forecasting activities for studies and programs * Oversee/collaborate on and contribute to inspection readiness activities that support audits and regulatory inspections related to clinical trial conduct * Maintain oversight and participate in the creation/review/training/maintenance of departmental and organizational SOPs to ensure compliance * Lead and/or participate in clinical operations workstreams related to departmental and operating model related initiatives * Develop and foster strong, collaborative relationships with key stakeholders both within and external to Moderna * Support program level deliverables/activities at the discretion of the Senior Director, Clinical Operations * Provide oversight and mentorship to assigned Clinical Trial Managers and Clinical Trial Associates by providing clinical operations and functional area expertise * Strive for continuous improvement and more efficient ways of working in clinical development * Act as a role model for Moderna's values Here's What You'll Bring to the Table: * Minimum of BA/BS with at least 8-10 years of trial and clinical program experience, including at least 4 years of independent clinical trial management experience and full trial life cycle experience (e.g., start-up, conduct, closure). Advanced degree preferred. * Robust experience in oncology required. Experience in late stage/phase 3 study leadership, including inspection readiness, required. Experience in immuno-oncology is desirable but not required. * Multi-dimensional Clinical Operations background with capability of devising plans for operational challenges such as site activation, subject enrollment, monitoring oversight, protocol deviation management, data cleaning, etc. * Cross-Collaboration proficiency with other functions such as Regulatory, CMC, Biostatistics, Data Management, Finance, Program Management, etc. * Experience in GCP inspections/audits * Outstanding verbal and written communication skills, in addition to excellent organizational skills * Proven track record of effective leadership and team-building skills in the context of a multi-disciplinary team in the biotech or pharmaceutical industry * Resilient, Creative, capable problem-solver * Excellent organizational skills and ability to work independently * Experience in establishing and maintaining relationships with key opinion leaders * Some travel required Pay & Benefits At Moderna, we believe that when you feel your best, you can do your best work. That's why our US benefits and global well-being resources are designed to support you-at work, at home, and everywhere in between. * Best-in-class healthcare coverage, plus voluntary benefit programs to support your unique needs * A holistic approach to well-being, with access to fitness, mindfulness, and mental health support * Family planning benefits, including fertility, adoption, and surrogacy support * Generous paid time off, including vacation, volunteer days, sabbatical, global recharge days, and a discretionary year-end shutdown * Savings and investment opportunities to help you plan for the future * Location-specific perks and extras The salary range for this role is $142,500.00 - $256,500.00. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. An individual's position within the salary range will be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, experience, skills, performance, and business or organizational needs. The successful candidate may be eligible for an annual discretionary bonus, other incentive compensation, or equity award, subject to company plan eligibility criteria and individual performance. About Moderna Since our founding in 2010, we have aspired to build the leading mRNA technology platform, the infrastructure to reimagine how medicines are created and delivered, and a world-class team. We believe in giving our people a platform to change medicine and an opportunity to change the world. By living our mission, values, and mindsets every day, our people are the driving force behind our scientific progress and our culture. Together, we are creating a culture of belonging and building an organization that cares deeply for our patients, our employees, the environment, and our communities. We are proud to have been recognized as a Science Magazine Top Biopharma Employer, a Fast Company Best Workplace for Innovators, and a Great Place to Work in the U.S. If you want to make a difference and join a team that is changing the future of medicine, we invite you to visit modernatx.com/careers to learn more about our current opportunities. Our Working Model As we build our company, we have always believed an in-person culture is critical to our success. Moderna champions the significant benefits of in-office collaboration by embracing a 70/30 work model. This 70% in-office structure helps to foster a culture rich in innovation, teamwork, and direct mentorship. Join us in shaping a world where every interaction is an opportunity to learn, contribute, and make a meaningful impact. Moderna is a smoke-free, alcohol-free, and drug-free work environment. Equal Opportunities Moderna is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry or citizenship, ethnicity, disability, military or protected veteran status, genetic information, sexual orientation, marital or familial status, or any other personal characteristic protected under applicable law. Moderna is a place where everyone can grow. If you meet the Basic Qualifications for the role and you would be excited to contribute to our mission every day, please apply! Moderna is an E-Verify Employer in the United States. We consider qualified applicants regardless of criminal histories, consistent with legal requirements. Accommodations We're focused on attracting, retaining, developing, and advancing our employees. By cultivating a workplace that values diverse experiences, backgrounds, and ideas, we create an environment where every employee can contribute their best. Moderna is committed to offering reasonable accommodations to qualified job applicants with disabilities. Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should contact the Accommodations team at leavesandaccommodations@modernatx.com. Export Control Notice This position may involve access to technology or data that is subject to U.S. export control laws, including the Export Administration Regulations (EAR). As such, employment is contingent upon the applicant's ability to access export-controlled information in accordance with U.S. law. Due to the nature of the work and regulatory requirements, only individuals who qualify as U.S. persons (citizens, permanent residents, asylees, or refugees) are eligible for this position. For this role Moderna is unable to sponsor non-U.S. persons to apply for an export control license. #LI-CK1 *
    $142.5k-256.5k yearly Auto-Apply 44d ago
  • Home Infusion Nurse - Accredo - Columbus, IN

    Cigna Group 4.6company rating

    Remote job

    Home Infusion Registered Nurse - Accredo Specialty Pharmacy Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: Active RN license in the state where you'll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver's license Willingness to travel to patients' homes within a large geographic region Ability to work 40 hours a week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
    $81k-114k yearly est. Auto-Apply 60d+ ago
  • Senior Director, Clinical Operations (TMF & CTMS)

    Summit Therapeutics Plc 4.5company rating

    Remote job

    site 4 days per week at our Menlo Park CA Princeton NJ or Miami FL office About Summit Ivonescimab also known as SMT112 is a novel potential first in class investigational bispecific antibody combining the effects of immunotherapy via a blockade of PD 1 with the anti angiogenesis effects associated with blocking VEGF into a single molecule Ivonescimab displays unique cooperative binding to each of its intended targets with multifold higher affinity when in the presence of both PD 1 and VEGF Summit has begun its clinical development of ivonescimab in non small cell lung cancer NSCLC with three active Phase III trials HARMONi is a Phase III clinical trial which intends to evaluate ivonescimab combined with chemotherapy compared to placebo plus chemotherapy in patients with EGFR mutated locally advanced or metastatic non squamous NSCLC who have progressed after treatment with a 3rd generation EGFR TKI eg osimertinib HARMONi 3 is a Phase III clinical trial which is designed to evaluate ivonescimab combined with chemotherapy compared to pembrolizumab combined with chemotherapy in patients with first line metastatic NSCLC HARMONi 7 is a Phase III clinical trial which is intended to evaluate ivonescimab monotherapy compared to pembrolizumab monotherapy in patients with first line metastatic NSCLC whose tumors have high PD L1 expression Ivonescimab is an investigational therapy that is not approved by any regulatory authority in Summits license territories including the United States and Europe Ivonescimab was approved for marketing authorization in China in May 2024 Ivonescimab was granted Fast Track designation by the US Food & Drug Administration FDA for the HARMONi clinical trial setting Overview of Role The Senior Director Clinical Operations TMF is a clinical research drug development expert accountable for leading and optimizing the delivery of our next generation integrated platform for clinical trial operations and document management systems including the people process technology that support these functions The individual leads transformative initiatives that create effective and efficient processes that meet high compliance standards; collaborating across Development focus on Clinical Operations; serving as a change manager to implement new systems and practices that support the organization as we continue to grow The Senior Director Clinical Operations TMF is an effective clinical operations team leader accountable for talent acquisition development management and evaluation of team members in hishertheir group This includes responsibility for the What delivery to performance goals and the How deliver consistent with Summit Therapeutics core values The individual is also a member of the Clinical Operations extended leadership team and as such supports and influences the direction of the Clinical Operations extended team The individual collaborates with team members to reinforce and operationalize strategic direction and solutions that support the ability to deliver on commitments to the organization and to patients Role and Responsibilities Develop implement and oversee the CTMS and TMF systems and related processes Lead the oversite of TMF and CTMS vendors contractors and cross functional teamsprovide leadership and development to existing TMF employees and lead by example by demonstrating our core values Define eexecute and communicate the strategic vision for TMF and CTMS to maximize end user focus and engagement Partner with key internal and external stakeholders to remediate risks and manage emerging issues Develop proactive approaches to process improvements and enhancements of TMF and CTMS capabilities and standards Provide business level leadership foster best practices and mentor and consult on TMF and CTMS across the Development and Operations organizations Lead a team of TMF and CTMs colleagues and ensure their continuous development Develop and maintain effective working relationships with stakeholder functions to achieve Clinical Operations goals Keep current on changes in industry and regulatory standards for GCP requirements and advises on business impact for TMF and CTMSProvide strategic leadership insight and guidance as an active member of the Clinical Operations Extended Leadership Team XLTEnsure inspection ready TMF and CTMS and provide expert support for audits and inspections Instill a culture of continuous improvement; acts as a change champion and effectively leads change Other key assignments including ad hoc and stretch assignments in support of Clinical Operations and clinical trial execution Travel on assignment 25All other duties as assigned Experience Education and Specialized Knowledge and Skills Bachelors degree eg BA BS or equivalent required; preferably in life science; a clinical or advanced degree in a science health related or industry related discipline is preferred Minimum of 12 years of strong experience with a pharmaceutical company andor CRO with increasing levels of responsibility in Clinical Operations in a global environment including directing platform support teams and key clinical systems such as TMF CTMS preferredA minimum of 5 years of experience in people managementleadership required Proven line and functional manager experience able to effectively lead teams including regional multi country and remote based staff Experience in Phase III execution of clinical trials; Oncology trials preferred Previous regulatory inspection experience preferred Strong comprehensive and current regulatory knowledge including ICH Good Clinical Practice regulations and guidelines Significant vendor oversight experience including contracts and budget management preferred The pay range for this role is 230000 250000 annually Actual compensation packages are based on several factors that are unique to each candidate including but not limited to skill set depth of experience certifications and specific work location This may be different in other locations due to differences in the cost of labor The total compensation package for this position may also include bonus stock benefits andor other applicable variable compensation Summit does not accept referrals from employment businesses andor employment agencies in respect of the vacancies posted on this site All employment businessesagencies are required to contact Summits Talent Acquisition team at recruitingsmmttxcom to obtain prior written authorization before referring any candidates to Summit
    $142k-218k yearly est. 10d ago
  • Regional Director, Clinical Operations VBC East

    U.S. Renal Care 4.7company rating

    Remote job

    USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization. SUMMARY Lead a regional team of clinical team members to drive quality patient outcomes in value-based care. Oversee operations, staffing, compliance, and workflows while partnering with physicians and dialysis facilities. Monitor performance metrics, implement process improvements, and talent management. Collaborate closely with cross-functional colleagues to develop and execute strategies to improve quality and reduce cost of care. Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned. Directly manages a team of Nurse Case Managers and Coordinators, providing direction, mentoring, and professional development. Coaches and mentors the team through regular team meetings, on-site shadowing, and other means. Conducts regular 1:1 meetings, team huddles, and comprehensive team meetings to ensure alignment and address concerns. Routinely reviews team metrics / scorecards with individual team members and the full team. Ensures optimal deployment and daily productivity of the clinical team, including by balancing caseloads and assignments. Supports nurses in optimizing their schedules and patients (e.g., prioritizing on-site work for nurses who have in-person responsibilities). Oversees payroll, PTO, expense management, and other Human Resources processes, ensuring accuracy and compliance. Addresses staffing needs by liaising with Human Resource Business Partners, conducting interviews, overseeing onboarding, and precepting new hires. Monitors compliance with professional licenses and manages credentialing processes. Implements core processes and workflows, including regular reviews of Optimal Starts patients, regular reviews of CVC patients, engagement with dialysis facilities, IDT meetings for key physician practices, and others as needed. Runs effective internal IDT meetings together with Associate CMO to review high risk patients, ensure the presence of strong care plans, and ensure execution against care plans. Partners with Market Operators to design and deploy workflows with each relevant physician practice and dialysis team. Ensures routine engagement of Nurse Case Managers and Coordinators with Risk Adjustment Nurse Practitioners, as appropriate, to support CDMV findings in being processed and acted upon. Monitors, analyzes, and reports on operational performance metrics, suggesting and implementing improvements to enhance efficiency. Leads reporting out on clinical team performance and issues during Monthly Operating Reviews. Develops close working relationships with dialysis facility administrators, and ensures that appropriate communication processes and other workflows are in place with Nurse Case Managers and dialysis teams to maximize impact of interventions for dialysis patients. Develops close relationships with physician practice leaders and administrators, and is seen as a key clinical resource to drive impact with the practice. Is routinely in the field with the team to provide in-person coaching and mentoring; travel required when not geographically close to team and partners. Key Performance Indicators include: Optimal Starts Admissions Readmissions Time on Dialysis CVC Rate
    $99k-168k yearly est. 1d ago
  • Tax Staff through Director--Major Corporation-Fully Remote!

    Tax Staffing Solutions

    Remote job

    We are seeking to rebuild our in-house tax department at levels since we relocated to Houston. Resume to: taxstaffing@gmail.com Duties include: Prepare federal and state (current and deferred) tax returns and provisions in accordance with ASC 740. analysis of effective tax rate, the reconciliation and analytical review of the tax accounts, and maintenance of deferred taxes inventory. Streamlined ASC 740 tax provision, and tax compliance processes by implementing OneSource Tax Provision software and integrating it with OneSource Income Tax software, which led to efficiency in financial reporting, reduction in professional service costs, and increase net profit. Kept track of tax software upgrade by keeping abreast of latest version update, determine how updates would improve the tax processes, and made system upgrade recommendation to superior if warranted. Drafted documentation of testing of internal controls under Sarbanes-Oxley 404 and update tax processes and controls.C Coordinate with outside Big 4 and law firms as well as other third parties. Led tax compliance efforts, including preparation of quarterly estimates and extension income/franchise tax payment calculations. Provided assistance in the information gathering process for the ongoing IRS and state tax audits. Conducted tax-related research to minimize company's federal and state income tax liability. Research and planning. Involvement with adminitrative and budge matters Attend tax seminars and conferences
    $62k-101k yearly est. 60d+ ago
  • Clinical, Manager, Prior Authorization Technician

    Capital Rx 4.1company rating

    Remote job

    About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Responsibilities: Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process. Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance. Actively participate in the prior authorization technician metric and quality goal setting process. Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders. Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees. Investigate/resolve escalated issues or problems from team members, clients, and other internal teams. Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions. Maintain relationships with external Independent Review Organizations and clinical resource vendors. Support the training and growth of both new and existing staff members in adherence to proper procedures. Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties. Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department. Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. Maintain compliance with local, state, and federal laws, in addition to established organizational standards. Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies Required Qualifications: Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required Bachelor's or Associate's degree is preferred 4+ years of PBM or Managed Care pharmacy experience required Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint Strong clinical background required Excellent communication, writing, and organizational skills Ability to multi-task and collaborate in a team with shifting priorities Preferred Qualifications: 2+ years of regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements Previous prior authorization operations leadership experience Salary Range$80,000-$90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************
    $80k-90k yearly Auto-Apply 1d ago
  • Regional Clinical Manager - Remote (Travel Required)

    Argentum Medical 3.4company rating

    Remote job

    Click here to view our 2025 Benefits Guide
    $62k-97k yearly est. Auto-Apply 60d+ ago
  • SDI Clinical Manager

    Parallel LLC 4.4company rating

    Remote job

    Role Type: Part-Time, Guaranteed 15 hours a week About This Role Are you ready to make a difference? Come join Parallel! We're searching for an experienced teacher to join our team! As our Specially Designed Instruction (SDI) Manager, you'll deliver the best services to our students and school partners, as well as work directly with our Director of Behavioral Mental Health Services to build, develop, and improve our program(s). This is a great opportunity for someone who wants to: Make an impact Help transform an antiquated industry Work somewhere mission-driven Work somewhere flexible, supportive, and collaborative Work somewhere with unparalleled opportunities for growth Join a female-led and DEI-focused organization Work somewhere that is team-oriented and where people are equipped to succeed Join a fast-growing startup, backed by top VCs, on the ground floor Why Join Us? Parallel makes it easy to administer quality care! By taking care of the daily hassles of running a business, we empower you to focus on providing services. We provide: Easy Scheduling through our in-house scheduling system Templates & Databases so you can spend less time on administrative tasks Smart Matching to pair you with clients Patient History & Eligibility information so you have the information you need Billing Services so you can focus on what matters Testing and Therapy Materials so you have the tools to succeed! Medical, vision, dental benefits and flexible PTO We also offer: Innovation: Your feedback will help shape the program for providers and clients in the future! Community Events: Collaborate with top clinicians and educators to solve acute problems Growth: Access leadership and growth opportunities as we rapidly scale A Great Mission: Empower students who learn or think in different ways What You'll Do Lead a Team and Support the growth of Parallel's Special Education Programs Provider mentorship, coaching, and clinical support to assigned portfolio of providers; including providing corrective feedback, feedback on instructional strategies, lesson planning, and IEP implementation, as well as sharing evidence-based resources and best practices Host team roundtables and provider meetings; includes provider training (workshops, continuing education sessions) Assist Parallel's talent team in recruiting and selecting new Special Education teachers; assist in screening applicants and reviewing applicant case studies Orient and train new service providers on Parallel processes and procedures Collaborate with the Sales and Customer Success Teams to align instructional service offerings with district needs, ensuring smooth implementation of SDI and academic support service Collaborate and support Provider and School Operations teams with day to day needs; including billing for services, scheduling, caseload management Work closely with school district administrators and teams to resolve potential concerns and to ensure students receive the services they need Support improvement and development of existing policy, procedure, and provider training content Assist with instructional quality assurance through review of lesson plans, progress reports, data collection practices, and IEP goal alignment; provide coaching and feedback to strengthen teaching practices Report to the Director of Clinical Excellence and Behavioral Mental Health Services What You'll Need To succeed in this role, you'll need: State Special Education license; National Board Certification preferred Preference for Special Education teachers who have experience in more than one state in a designated region Minimum of 5 years of classroom teaching or special education service experience, including work with students requiring SDI, resource support, or inclusion services Flexible schedule to internal and school meetings Prior leadership and mentorship experience to mentor and grow a team Experience participating in eligibility/IEP meetings, acting as a case manager, strong understanding of IDEA compliance, IEP processes, and instructional accommodations/modification Excellent communication skills and self-awareness to communicate with individuals from a variety of backgrounds and life experiences; including children, families, and school partners Proficiency with virtual learning platforms and digital instructional tools for tele-education A private workspace with a secure and reliable internet connection 👋 About Us Parallel is the first tech-forward provider of care for learning and thinking differences across the United States. We believe learning differences are parallel ways of thinking that should be celebrated! Our mission is to provide students with the resources and encouragement to succeed in the classroom and beyond. To us, this means helping them build confidence in their unique strengths and create strategies to work around their challenges. Parallel simplifies the process of getting support for learning differences by consolidating providers and resources on a single platform. We connect students with qualified professionals while significantly reducing waiting times, costs, and confusion. We provide a variety of services, including: Psychological Assessment & Therapy Counseling Speech-Language Therapy Special Education And more! Want to know what it's like working here? Check out our Glassdoor reviews! Our commitment to diversity, equity, and inclusion At Parallel, we believe in celebrating differences. This belief extends from schools into our workplace and through the ways we work together toward our mission. We are committed to fostering a diverse, accessible environment that represents many different cultures, backgrounds, viewpoints, and abilities by championing diversity, equity and inclusion. This is why we are committed to having and fostering a diverse workforce, including those from historically marginalized groups, and are committed to a work environment where employees' strengths are championed, differences are celebrated, and no one is discriminated against based on age, race, ancestry, religion, sex, gender identity and expression, sexual orientation, pregnancy, marital status, physical or mental disability, military or veteran status, national origin, or any other characteristic. We are a proud equal opportunity employer, and we are committed to building a diverse, equitable, and inclusive organization in order to build the foundation for different learners and thinkers to thrive. By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message. Message & data rates may apply. Reply STOP to opt out of further messaging.
    $64k-103k yearly est. Auto-Apply 46d ago
  • Clinical Delegation Manager

    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 Clinical Delegation Manager supports delegated provider performance by monitoring relationships with delegated partners ensuring compliance, and achievement of organizational strategy as outlined in contracts. This position serves as a delegation subject matter expert and provides a broad range of coordination and operational support to the Office of Clinical Affairs (OCA), including the National Committee for Quality Assurance (NCQA) accreditation, quality improvement, and care management teams. The Clinical Delegation Manager is the key clinical delegation contact to the delegated provider's leadership team regarding escalated issues as they arise. The position is responsible for both NCQA delegation oversight to the delegated providers and as a SME for all Population Health Management standards for internal and external partners. The Clinical Delegation Manager collaborates with various Boston Medical Center Health System population health management teams to ensure alignment of activities related to delegated quality contract requirements and adherence to NCQA accreditation requirements. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: Contribute to development and implementation of delegation best practices Build and maintain collaborative relationships with delegated provider and internal care management leadership to promote engagement with WellSense Population Health programs, optimize performance, and foster information exchange. Serve as the point person/subject matter expert (SME) for NCQA standards delegated to the providers, and issues submitted by the providers. Promptly resolve concerns or elevate to the appropriate level. Assist in the design of interventions to advance quality and efficiency initiatives and provide consultative support to delegated providers. Develop and maintain organizational policies and procedures related to delegation oversight. Lead regular delegation joint oversight meetings Quality performance Track common themes/structures/tactics across highest performing delegated providers and create best practice definition Engage delegated provider leaders and internal care management in the process of sharing best practices Monitor success of implemented quality measures Support NCQA delegation activities and ensure compliance with standards and regulations Conduct delegation oversight assessments Care Management performance Support the implementation and maintenance of care management programs (focused on particular disease states or more general) that will impact utilization metrics and health outcomes Conduct delegation oversight annual evaluation and ongoing audits; develop corrective action plans to remediate identified deficiencies Provider engagement Work with delegate provider leadership and staff to identify and implement best practices for engaging providers in population health programs Track engagement measures and share insights with WellSense leaders Track and Analyze Delegated Provider and Internal Care Management Performance Track performance metrics. Review and analyze data to assess quality performance. Advise WellSense leadership on performance improvement opportunities via the Care Management Steering Committee and/ or the Quality Improvement Committee. Work with Clinical Informatics, Network Management, Quality, Care Management, and Clinical Operations staff to assess performance and craft solutions to improve metrics. Other duties as assigned Supervision Exercised: None Supervision Received: General direction received weekly from the Senior Manager Delegation and Quality Partnerships Qualifications: Education Required: Bachelor's degree required. Education Preferred: Bachelors of Science degree in Nursing (BSN) preferred Master's degree (MSN, MBA, MPH, etc.) preferred Experience Required: 7+ years of healthcare experience; some care management or outpatient ambulatory care experience preferred Advanced knowledge of NCQA PHM standards Experience Preferred/Desirable: Experience within a managed care organization is strongly preferred Conditions of Employment: Successful completion of pre-employment background check Preferred Licensure, Certification Registered nurse with active license as applicable Competencies, Skills, and Attributes: Project management training or comparable experience in managing complex interdisciplinary projects or programs. A strong working knowledge of Microsoft Office products. Detail oriented with excellent proof reading and editing skills. Effective collaborative and proven process improvement skills. Strong oral and written communication skills; ability to interact within all levels of the organization. Demonstrated commitment to excellent customer service. Knowledge and understanding of current trends in healthcare. Aptitude for aligning process, projects, and people to meet business goals in cross-functional team settings. Demonstrated past experience in delivering team success via data-driven metrics & reporting. Experience with matrix team management. Working Conditions and Physical Effort: Regular and reliable attendance is an essential function of the position. Work is normally performed in a typical interior/office work environment. No or very limited physical effort required. No or very limited exposure to physical risk. 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.
    $67k-105k yearly est. 60d+ ago
  • Project Manager - Clinical Research Pathology Services

    Deciphex

    Remote job

    Role Type and Location Work from home role - this role requires you to be based full time in the East Coast, USA. Eligibility to work Unfortunately, we cannot offer USA based Visa sponsorship for this full time USA BASED role. Role Summary We are seeking a proactive and detail-oriented Project Manager to support the delivery of pathology-focused clinical trial projects at Diagnexia Analytix. Sitting under the Clinical Trial Manager, this role will act as the operational driver of projects - ensuring that timelines, deliverables, and quality standards are met across complex, multi-stakeholder clinical studies. The Project Manager will not design the science, but will make sure the science happens: coordinating vendors, labs, pathologists, and internal teams, while keeping communication clear and projects audit-ready. Key Responsibilities Project Delivery & Coordination Translate Statements of Work (SoWs) into actionable project plans, timelines, and trackers. Manage day-to-day execution, logistics, and operational workflows. Oversee sample flow, staining, scanning, and digital pathology processes. Pathologist Management, training and communication Stakeholder Communication Serve as a central point of contact between sponsor, CRO, central labs, and internal teams. Organize and document sponsor calls, training sessions, consensus/adjudication meetings. Maintain action logs, decision records, and issue escalation pathways. Quality & Compliance Ensure all activities follow GCP/GCLP, ICH E6, and regulatory standards. Support preparation of validation reports, pathology manuals, final study reports, and archival outputs. Track QC metrics, deviations, CAPA actions, and maintain audit readiness. Risk & Change Management Maintain a risk register for timelines, logistics, and deliverables. Coordinate structured change control processes when scope or timelines shift. Required Skills & Experience (Must-Have) Degree in life sciences, biomedical sciences, or a related discipline. 3-5 years' experience in clinical trial project management, CRO operations, or translational/biomarker projects. Strong knowledge of GCP/GCLP and ICH E6 standards. Proven ability to deliver multi-stakeholder projects on time and within scope. Excellent organizational skills; able to manage multiple vendors, labs, and deliverables. Strong communication skills, with experience preparing reports, dashboards, and running status calls. Ability to anticipate issues, escalate appropriately, and drive solutions. Proficiency with project management tools (e.g., Smartsheet, MS Project, Asana) and shared document platforms. Preferred Skills & Experience (Nice-to-Have) Exposure to pathology, histology, or biomarker assay workflows. Experience coordinating pathologists and pathology vendors. Familiarity with digital pathology platforms (WSI, image hosting, secure data transfer). Therapeutic area experience in oncology, immunology, or liver disease trials. Formal PM certification (PMP, PRINCE2) or Lean/Agile training. Strong interpersonal skills: able to “manage up” to senior stakeholders while motivating delivery teams. Experience in a scale-up/fast-growing environment. Ideal Candidate Profile A “doer” who thrives on making things happen in complex clinical projects. Comfortable working alongside scientific leaders while taking responsibility for operations, timelines, and compliance. Highly organized, proactive, and able to bring structure and accountability to dynamic, multi-stakeholder studies. What are the benefits of working with Deciphex 💰 Competitive salary with annual performance-based increases. Rewarding your impact and growth 🩺 Healthcare benefits, giving you peace of mind to focus on what you do best 🌴 Annual leave with service increments - Means more time to recharge and enjoy life outside work 💡 Pension contributions, helping you build a secure future 🚀 Work with a world-class, high-performing team in a hyper-growth startup. You'll earn fast, make an impact, and shape the future 📈 Regular feedback and clear career growth opportunities. You keep developing and moving forward 🌍 A collaborative, supportive, multicultural team. Here you'll feel valued and inspired every day About the Company Through the work that we do, the team at Deciphex helps pharma to accelerate the process of essential drug development and helps patients to get timely and accurate diagnosis. Founded in Dublin in 2017, Deciphex has scaled rapidly to a team of over 180 people and counting who are providing software solutions to address the pathology gap in research pathology and clinical areas. We have offices in Dublin, Exeter, Oxford, Toronto and Chicago and are expanding our team throughout the world. We are software developers, clinical specialists, AI engineers, operations professionals and so much more, all working as one team to support our customers and patients. Our team culture is built on trust. We give our team the space they need to deliver results and the environment to ensure they can enjoy doing it. We are looking for highly motivated individuals who are excited to take on challenges and value making a difference in their day-to-day work. This is a unique opportunity to make a difference in the emerging Digital Pathology field. Read more about Deciphex here and more about our incredible team on our Careers Page here
    $66k-102k yearly est. 51d ago
  • Clinical Manager - Seating and Positioning

    Etac Ab

    Remote job

    The Clinical Manager is responsible for developing and implementing clinical training curricula detailing the application and fitting of the designated Etac product area to achieve positive functional outcomes. This position trains providers, therapists, and sales associates in the form, fit, and function of Etac products and their clinical applications. This is a traveling position providing product presentations, clinical in-services, and product/client fittings with providers and/or clinicians and provides one-on-one training with sales associates with the goal of supporting efforts to increase sales of all designated Etac products. The role also supports and leads larger in-person clinical product education and training engagements with key customers. Product Areas: Seating & Positioning: all Etac North America Mobility custom and “packaged” seating products, including Axiom, Axiom Kids, Axiom Custom Back, Axiom Custom Seating, Star Cushions, secondary positioning supports, and other products and accessories as they may be designated in the future. Mobility: all Etac North America Mobility manual wheelchairs and related accessories or components, including power assist. This includes manual wheelchair in the folding, rigid, tilt-in-space, pediatric and adolescent categories, as well as, any products and accessories as they may be designated in the future. Pediatrics: all Etac North America Mobility products intended for use by the pediatric population. This includes all products, accessories, or components from R82, Convaid, Ki Mobility, including power assist. This will also include any products and accessories as they may be designated in the future. Essential FunctionsJob Responsibilities Assist in the development of clinical training curricula relating to relevant Etac products. Create and deploy training materials that will be used by sales associates, export partners, and other clinical education team members. Establish and maintain a travel schedule with Etac sales associates centered around in-field customer and clinician engagements. Attend trade shows, customer events, and sales meetings as necessary. Contribute to the development of the company's strategic plan to drive future growth and profitability for relevant Etac products. Present professional continuing education content (CEUs) as needed, either through coordination with sales associates and managers, or at key business partner education events. Manage sales expenses within the guidelines of the Company expense policy. Work closely with the sales team, specifically Territory Sales Managers, to align training initiatives with sales strategies and customer needs. Collaborate with cross-functional teams to align and deliver product education and training programs. Uphold Company values and ethical business conduct, as well as, maintain confidentiality of sensitive information. Utilize sales and order analysis tools, including Qlik, to strategically plan and prioritize travel to optimize effectiveness. Utilize sales and order analysis tools, including Qlik, post-travel to analyze effectiveness of travel and/or training curricula. Be a key contributor to product development requirements around competitive opportunity, clinical requirements and efficacy that deliver strong new product enhancements that meet market needs. Ensure and follow safety, quality, and other company requirements and standards. Keep the work area clean and orderly. Perform all duties in a manner that follows, demonstrates, and promotes Company's values. Report to work as scheduled, on time, and able to work entire work schedule. Perform additional duties as assigned. Knowledge, Skills, and Ability Excellent presentation skills and confidence in front of small and large groups. Strong organizational skills. Strong Microsoft PowerPoint skills. Knowledge and proficiency with Microsoft Office Suite products, including Excel and Outlook, and other enterprise software. In depth knowledge of clinical issues relating to disabled populations. Knowledge of manual mobility and seating products than span adult and pediatric solutions within the complex rehabilitation industry. Ability to establish and maintain professional communications both inside and outside the company. Funding knowledge within complex rehab technology. Ability to network with providers, ATP's, clinicians, and caregivers. A high level of interactive communication is required to service our customers and clinicians; must be able to respond quickly and effectively to satisfy customer and clinician inquiries. Possess a strong business acumen with an understanding of market potential and contract development. Analytical skills in order to solve complex problems and make informed decisions. Possess excellent written and oral communication and interpersonal skills to collaborate effectively with cross-functional teams. Proactive and self-motivated with the ability to work independently and in a team environment. Ability to lift and handle wheelchairs. Ability to observe and identify details. Ability to work extended hours as scheduled, including weekends. Physical Demands Frequent sitting, wrist manipulation, walking, and standing. Frequent bending, pushing, pulling, and twisting. Occasional to frequent driving in a vehicle. Frequent light/medium work with lifting up to 30 pounds. Occasional medium work with lifting up to 50 pounds. Must be able to lift, handle, load, and unload all products. Manual dexterity to type and operate office equipment frequently. Must be able to complete all physical requirements to perform essential functions. QualificationsEducation/Experience Degree in a clinical discipline (Occupational or Physical Therapy, Kinesiology) or a related field or 3-5 years of experience in the complex rehab industry. ATP certification is beneficial. Must possess and maintain a valid driver's license. Intermediate level experience with computer applications. Working Environment Remote position with an expectation of up to 75% travel focusing on specific key referral sources, their clinicians, providers, and ATP's. This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the associate for this position. Duties, activities, and responsibilities may change, or new ones may be assigned at any time with or without notice. Associate must be able to satisfactorily perform the essential functions of the position with or without reasonable accommodations. Ki Mobility is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
    $53k-86k yearly est. Auto-Apply 55d ago
  • Clinical Manager - Seating and Positioning

    Ki Mobility 4.2company rating

    Remote job

    The Clinical Manager is responsible for developing and implementing clinical training curricula detailing the application and fitting of the designated Etac product area to achieve positive functional outcomes. This position trains providers, therapists, and sales associates in the form, fit, and function of Etac products and their clinical applications. This is a traveling position providing product presentations, clinical in-services, and product/client fittings with providers and/or clinicians and provides one-on-one training with sales associates with the goal of supporting efforts to increase sales of all designated Etac products. The role also supports and leads larger in-person clinical product education and training engagements with key customers. Product Areas: Seating & Positioning: all Etac North America Mobility custom and “packaged” seating products, including Axiom, Axiom Kids, Axiom Custom Back, Axiom Custom Seating, Star Cushions, secondary positioning supports, and other products and accessories as they may be designated in the future. Mobility: all Etac North America Mobility manual wheelchairs and related accessories or components, including power assist. This includes manual wheelchair in the folding, rigid, tilt-in-space, pediatric and adolescent categories, as well as, any products and accessories as they may be designated in the future. Pediatrics: all Etac North America Mobility products intended for use by the pediatric population. This includes all products, accessories, or components from R82, Convaid, Ki Mobility, including power assist. This will also include any products and accessories as they may be designated in the future. Essential FunctionsJob Responsibilities Assist in the development of clinical training curricula relating to relevant Etac products. Create and deploy training materials that will be used by sales associates, export partners, and other clinical education team members. Establish and maintain a travel schedule with Etac sales associates centered around in-field customer and clinician engagements. Attend trade shows, customer events, and sales meetings as necessary. Contribute to the development of the company's strategic plan to drive future growth and profitability for relevant Etac products. Present professional continuing education content (CEUs) as needed, either through coordination with sales associates and managers, or at key business partner education events. Manage sales expenses within the guidelines of the Company expense policy. Work closely with the sales team, specifically Territory Sales Managers, to align training initiatives with sales strategies and customer needs. Collaborate with cross-functional teams to align and deliver product education and training programs. Uphold Company values and ethical business conduct, as well as, maintain confidentiality of sensitive information. Utilize sales and order analysis tools, including Qlik, to strategically plan and prioritize travel to optimize effectiveness. Utilize sales and order analysis tools, including Qlik, post-travel to analyze effectiveness of travel and/or training curricula. Be a key contributor to product development requirements around competitive opportunity, clinical requirements and efficacy that deliver strong new product enhancements that meet market needs. Ensure and follow safety, quality, and other company requirements and standards. Keep the work area clean and orderly. Perform all duties in a manner that follows, demonstrates, and promotes Company's values. Report to work as scheduled, on time, and able to work entire work schedule. Perform additional duties as assigned. Knowledge, Skills, and Ability Excellent presentation skills and confidence in front of small and large groups. Strong organizational skills. Strong Microsoft PowerPoint skills. Knowledge and proficiency with Microsoft Office Suite products, including Excel and Outlook, and other enterprise software. In depth knowledge of clinical issues relating to disabled populations. Knowledge of manual mobility and seating products than span adult and pediatric solutions within the complex rehabilitation industry. Ability to establish and maintain professional communications both inside and outside the company. Funding knowledge within complex rehab technology. Ability to network with providers, ATP's, clinicians, and caregivers. A high level of interactive communication is required to service our customers and clinicians; must be able to respond quickly and effectively to satisfy customer and clinician inquiries. Possess a strong business acumen with an understanding of market potential and contract development. Analytical skills in order to solve complex problems and make informed decisions. Possess excellent written and oral communication and interpersonal skills to collaborate effectively with cross-functional teams. Proactive and self-motivated with the ability to work independently and in a team environment. Ability to lift and handle wheelchairs. Ability to observe and identify details. Ability to work extended hours as scheduled, including weekends. Physical Demands Frequent sitting, wrist manipulation, walking, and standing. Frequent bending, pushing, pulling, and twisting. Occasional to frequent driving in a vehicle. Frequent light/medium work with lifting up to 30 pounds. Occasional medium work with lifting up to 50 pounds. Must be able to lift, handle, load, and unload all products. Manual dexterity to type and operate office equipment frequently. Must be able to complete all physical requirements to perform essential functions. QualificationsEducation/Experience Degree in a clinical discipline (Occupational or Physical Therapy, Kinesiology) or a related field or 3-5 years of experience in the complex rehab industry. ATP certification is beneficial. Must possess and maintain a valid driver's license. Intermediate level experience with computer applications. Working Environment Remote position with an expectation of up to 75% travel focusing on specific key referral sources, their clinicians, providers, and ATP's. This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the associate for this position. Duties, activities, and responsibilities may change, or new ones may be assigned at any time with or without notice. Associate must be able to satisfactorily perform the essential functions of the position with or without reasonable accommodations. Ki Mobility is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
    $52k-70k yearly est. Auto-Apply 55d ago
  • Clinical Manager, Care Management Services (Remote)

    Author Health

    Remote job

    Clinical Manager of Care Management Services (Remote) At Author Health, we're revolutionizing how mental health care is delivered, and we want you to be part of it! Our mission is to bring compassionate, high-quality care to people with serious mental illness, substance use disorders, and dementia, including older adults. We don't just treat symptoms. We treat people - fully, holistically, and with heart! Through our virtual-first, innovative care model, we deliver community-based wrap-around outpatient mental health care inclusive of psychiatric, psychotherapeutic and care management services. We partner with primary care providers, hospitals, families, and caregivers to keep patients out of the hospital and empower them to live healthier, more connected lives. At Author, inclusivity isn't a checkbox. It's how we build trust and drive better outcomes! We honor the unique cultures, identities, and stories that shape every patient's experience, and we're creating a workplace where team members can show up as their full selves, too. If you're driven by purpose, ready to shake up the status quo, and eager to make a real impact in people's lives, we'd love to meet you. Let's build the future of mental health care together! We are seeking a dynamic and experienced Clinical Manager of Care Management Services to oversee and coordinate comprehensive care management services across both behavioral health and medical care settings. This clinical leadership role is critical in ensuring the seamless delivery of integrated care, optimizing patient outcomes, and promoting the efficient and effective utilization of resources within our organization. WHAT IS YOUR SUPERPOWER? * Develop, implement, and oversee care management policies, procedures, and protocols for behavioral health and medical care. * Lead and supervise a multidisciplinary Care Management team organized in a "pod" model where: * Care Managers (Registered Nurses and Behavioral Health Care Managers) are responsible for comprehensive care planning and clinical coordination, * Licensed Practical Nurses (LPNs) focus on post-discharge outreach, coordination, and Transitional Care Management (TCM), while * Patient Resource Specialists (PRSs) support our patients by addressing health-related social needs and social determinants of health. * Manage care coordination processes across multiple payor environments, ensuring consistent standards of care, regulatory alignment, and effective operational workflows. * Support the design and implementation of strategic initiatives that enable Author Health to innovate by piloting modifications or new builds in our care delivery model. * Coach members of the Care Management team to enhance performance on both clinical quality and overall efficiency - do so while using a data-driven approach, and by regularly shadowing and auditing individual team members (e.g., auditing calls and documentation). * Collaborate closely with interdisciplinary teams of health care providers both within and outside of Author Health, including physicians, nurses, therapists, and social workers, to ensure integrated care planning and delivery. * Conduct regular assessments of patient needs, develop individualized care plans, and monitor progress towards goals. * Coordinate transitions of care and ensure continuity across different levels of care and health care settings. * Monitor and analyze data related to care management outcomes, utilization, and quality improvement initiatives. * Ensure compliance with regulatory requirements related to care management and patient care. * Participate in interdisciplinary meetings and committees to enhance coordination and communication across departments. * Serve as a resource for staff, patients, and families regarding care management services, resources, and community referrals. * Promote a culture of excellence, professionalism, and continuous improvement within the Care Management team. * Perform other duties as assigned to support departmental and organizational needs. WHAT WE ARE SEEKING: * Bachelor's degree in Nursing; Master's degree preferred. * Experience building and leading teams * Minimum of 5 years of Nursing experience in care management, preferably in behavioral health or medical care settings. * Proven leadership and supervisory experience with strong team-building skills. * Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders. * Solid understanding of health care regulations, policies, and reimbursement practices. * Strong analytical skills and the ability to use data for decision-making and quality improvement. * Certification in Case Management (CCM, ACM, or similar) preferred WHAT WE OFFER: * Retirement savings plan (401k) Plan up to 3.5% company match * Low cost benefits package for employee and dependents ( medical/ dental/ vision/ STD/ Life Insurance) * Paid vacation * Paid sick leave * 9 paid holidays throughout the year with (2) additional flex holidays .. 11 in total! * Performance-based bonuses * and more! NEXT STEPS: * Submit an application * Upload an updated resume * Share LinkedIn profile and/or cover letter Author Health is committed to a diverse and inclusive workplace. It is the company's policy to comply with all applicable equal employment opportunity laws by making all employment decisions without unlawful regard or consideration of any individual's race, religion, ethnicity, color, sex, sexual orientation, gender identity or expressions, transgender status, sexual and other reproductive health decisions, marital status, age, national origin, genetic information, ancestry, citizenship, physical or mental disability, veteran or family status or any other basis protected by applicable national, federal, state, provincial or local law. The company's policy prohibits unlawful discrimination based on any of these impermissible bases, as well as any bases or grounds protected by applicable law in each jurisdiction. We are committed to providing an inclusive and accessible experience for all applicants. If you require any accommodations at any stage of the process, please let us know. The company is pleased to provide such assistance and no applicant will be penalized as a result of such a request. In accordance with applicable legal requirements such as the San Francisco Fair Chance Ordinance Author Health will consider for employment qualified applicants with arrest and conviction records. Monday through Friday, 8am-5pm EST
    $66k-102k yearly est. Auto-Apply 15d ago
  • Clinical Service Excellence Manager - Remote

    Access Telecare

    Remote job

    Who we are: Access TeleCare is the largest national provider of telemedicine technology and solutions to hospitals and health systems. The Access TeleCare technology platform, Telemed IQ, enables life-saving patient care through telemedicine and empowers healthcare organizations to build telemedicine programs in any clinical specialty. We provide healthcare teams with industry-leading solutions that drive improved clinical care, patient outcomes, and organizational health. We are proud to be the first provider of acute clinical telemedicine services to earn The Joint Commission's Gold Seal of Approval and has maintained that accreditation every year since inception. We love what we do and if you want to know more about our vision, mission and values go to accesstelecare.com to check us out. What you'll be responsible for: The Clinical Service Excellence Manager will be responsible for overseeing all clinical processes and serving as the client champion for Access TeleCare's Neurology programs. In this role, you will have the opportunity to build effective relationships with client stakeholders, develop clinician workflows, support new program implementation, create action plans to support service performance, and interface with clinicians to facilitate clinical excellence. In addition, this you will serve as the clinical point of contact for practice issues for partner sites. What you'll work on: Participate in program launches and support with the development of clinical workflows Maintain working rapport with individual providers covering the service as needed to address clinical workflow or practice issues, and communicating recommended changes to medical director and hospital(s) affected Build and maintain positive working relationships with partner facility clinical staff; train partner staff on tasks that promote clinical workflow efficiency such as cart coordination, and address concerns in a timely manner Analyze and present reports on healthcare processes and patient outcomes to identify and prioritize areas for improvement Coordinate performance improvement activities focused on specific patient services or organizational quality initiatives through the use of specific benchmarks and evidence-based practices Participate in efforts to establish and maintain organizational readiness to meet regulatory requirements based on service line specialty Collaborate closely with Neurology Practice Administrator and Service Line Chief to work on team initiatives, develop and report KPIs, identify opportunities within programs to improve communication, efficiencies, and processes What you'll bring to Access TeleCare: Bachelor of Science in Nursing from an accredited school of nursing At least three years of experience in neurology service line, inpatient services preferred (required) Prior experience as a charge nurse or nurse supervisor (preferred) Ability to navigate multiple EMR systems required Excellent computer skills and familiarity with Microsoft Office programs including Excel for data manipulation Excellent interpersonal communication skills and the ability to exercise empathy when working with patients and their families Excellent organizational and time management skills Demonstrate an understanding of standard clinical procedures, laws, and regulations Thorough knowledge of medical terminology Ability to work independently, but function as part of a team Work Environment and Schedule: High growth fast paced organization Primarily remote based environment Not more than 20 days travel to select sites annually Travel quarterly to corporate office in Dallas, TX Must be able to remain in a stationary position 50% of the time. Company perks: Health Insurance (Medical, Dental, Vision) Health Savings Account Flexible Spending (Medical and Dependent Care) Employer Paid Life and AD&D (Supplemental available) Flexible Vacation, Wellness Days, and Paid Holidays About our recruitment process: We don't expect a perfect fit for every requirement we've outlined. If you can see yourself contributing to the team, we would like to speak with you. You can expect up to 4 interviews via Zoom. Access TeleCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, age, religion, color, marital status, national origin, gender, gender identity or expression, sexual orientation, disability, or veteran status.
    $48k-77k yearly est. Auto-Apply 52d ago
  • Telehealth Clinical Manager - Remote

    Gateway Rehabilitation Center 3.6company rating

    Remote job

    Ready to Elevate Addiction Recovery? If you're looking to redefine the way care is delivered and be at the forefront of addiction recovery, we have the career for you! Your expertise and compassion can change lives-one virtual session at a time Gateway Rehab Center (GRC) is seeking a passionate and skilled Clinical Manager to revolutionize the way we deliver care. This management position allows you to bring compassion, innovation, and expertise to individuals on their journey to recovery-all from the comfort of your home with occasional travel to a GRC location. If you're driven by the mission of making high-quality, accessible care a reality for all, we want to hear from you! Please Note: This is a remote position with occasional travel to a GRC facility in Robinson, PA. Ideal candidate should live in the Pittsburgh area or surrounding counties. Why Choose Gateway Rehab? Make an impact through Gateway's mission “to help all affected by addictive disease to be healthy in body, mind, and spirit.” Be a part of an organization that has been leading the way in addiction treatment for over 50 years. Leverage cutting-edge telehealth technology to bridge gaps in care and transform lives. Enjoy the flexibility of a remote role while maintaining meaningful client Why This Role is the Future of Addiction Treatment? GRC's Telehealth Services team is changing lives, and as a Clinical Manager you'll be at the forefront of this movement. Your work will expand access to critical services, empower clients, and shape the future of addiction recovery. This is more than just a job-it's a mission-driven career where you can make a lasting impact every single day. Your Role in Transforming Recovery Conduct authorization audits to ensure timely completion, avoiding any disruption in payments. Develops a training curriculum for Aura/m.care, tailored for new hires in all Telehealth positions. Performs chart audits for compliance of all new admissions, ensuring deadlines are met and sending reminders to staff with outstanding documentation. Maintains staff training records and identify training opportunities based on areas of need, as recommended by the Director or Executive Director. Oversees patient program attendance, ensuring compliance with policies and licensure requirements, particularly for psych services and IOP. Conducts documentation audits across different levels of care to ensure timely completion of all required items. Attends mandatory GRC trainings and in-services. Requirements What We're Looking For Master's degree in field that meets Pennsylvania Department of Health staffing qualification regulations required. License or certification from the Pennsylvania Certification Board eligible. Two years' clinical experience in a health or human service agency, including one year working directly with chemically dependent persons. Supervisory experience preferred. Knowledge of Substance Use Disorders and Evidence-based treatment methods. Strong leadership skills. Ability to manage crisis, make decisions, and make sound clinical judgements. Excellent written and verbal communication skills. Additional Requirements Pass PA Criminal Background Check. Obtain PA Child Abuse and FBI Fingerprinting Clearances. Pass Drug Screen. TB Test. Work Conditions Remote with travel into a GRC facility. Favorable working conditions. Minimal physical demands. GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.
    $31k-38k yearly est. 18d ago
  • Clinical Review Manager

    Bluecross Blueshield of Tennessee 4.7company rating

    Remote job

    Join the BlueCare team at BCBST as a Clinical Review Manager! In this role, you will complete medical reviews for utilization management within the BlueCare member population. You'll have the opportunity to collaborate with the BlueCare Utilization Management team, Case Managers, and other departments. The ideal candidate for this role is a quick learner who thrives in a role that requires attention to detail and research skills. The role also requires the ability to navigate clinical information and disseminate it in a timely manner. Finally, we're looking for a candidate with strong communication skills to be able to work effectively across multiple teams. Key Schedule Details: Typical schedule is 8-5 pm EST or 9-6 pm EST. Fully remote, at home position. There is an option, upon management approval, for alternative workdays or a compressed work schedule. For example, the Clinical Review Manager may work five 8-hour shifts or four 10-hour shifts, which may include a combination of weekdays and weekends (e.g., Wednesday-Sunday or Thursday-Sunday)." Join our team and make a significant impact on the quality of care our members receive! Job Responsibilities Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Assists non-clinical staff in performance of administrative reviews Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. Occasional weekend work may be required. Must be able to pass Windows navigation test. Testing/Assessments will be required for Digital positions. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required Skills\Certifications Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Working knowledge of URAC, NCQA and CMS accreditations Must be able to work in an independent and creative manner. Excellent oral and written communication skills Strong interpersonal and organizational skills Ability to manage multiple projects and priorities Adaptive to high pace and changing environment Customer service oriented Superior interpersonal, client relations and problem-solving skills Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
    $84k-98k yearly est. Auto-Apply 48d ago

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