Vice President, Government and Commercial Programs Allied UniversalVice President, Government and Commercial ProgramsNYRemote$130,000–$160,000 / yearThe Vice President, Government and Commercial Programs is responsible for all government and commercial healthcare operations in addition to managing interactions with government entities while concurrently developing and executing strategies to drive commercial growth and Profit & Loss (P&L) responsibility across both public and private sectors. Responsible for the day-to-day oversight of the operational efficiency and effectiveness of the clinical auditing, compliance and special investigations unit organization, to include special programs such as Physician, Managed Care, Pharmacy, PACE, and Special Needs.
Utilization Management Clinician Behavioral Health Night Shift - 4 Days CVS Health CorpUtilization Management Clinician Behavioral Health Night Shift - 4 DaysNYRemote$54,095–$142,576 / yearAbility to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary. Join our Utilization Management team and help ensure members receive timely, appropriate behavioral health services while making a meaningful impact on outcomes.
Clinical Case Manager Blue Cross and Blue Shield AssociationClinical Case ManagerNYRemote$75,000–$85,000 / yearSupport members at all stages of their health care journey and across multiple settings and specialty areas, connecting with multiple providers and community-based organizations; guide members in accessing services to support their health and wellness goals in accordance with their benefits, partnering effectively with the Plan's customer service, providers relations, and/or utilization management teams. Clinical Case Manager Qualifications: Graduate of an approved program in professional nursing: RN, VT licensure and ability to apply for Compact License or active multi-state licensure required, BSN desired; OR Licensed Clinical Social Worker (LICSW) in the State of Vermont or comparable degree and licensure in an allied mental health profession.
Senior Clinical Informaticist Cohere Health Technologies LLCSenior Clinical InformaticistNYRemote$75,000–$100,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Physician - Virtual Urgent Care Oscar Health IncPhysician - Virtual Urgent CareNew York, NYRemote$227,226–$298,233 / yearParticipate in collaborative care model with various care team members including but not limited to registered nurses, medical assistants, PCPs, behavioral health clinicians, and clinical supervisor where applicable. Compact license from IMLCC or eligible for a compact license (hold a full, unrestricted medical license in a state that is a member of the Compact).
Education Manager, Clinical (Grievance & Appeals) VNS HealthEducation Manager, Clinical (Grievance & Appeals)New York, NYRemote$98,200–$130,800 / yearEnsures clinical education programs are aligned with CMS Triple Aim framework: improving the patient's experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.
Senior Director of Product Compliance Metroplus Health Plan IncSenior Director of Product ComplianceNew York, NYRemote$190,000–$210,000 / yearThe Senior Director of Product Compliance, reporting to the Vice President of Compliance, provides strategic leadership and oversight for MetroPlusHealth's Product Compliance and External Audit functions across all lines of business, including Medicaid, HIV SNP, HARP, CHP, Essential Plan, QHP, Large Group, Medicare, MAP, MLTC, and other integrated products. This role is responsible for leading the State Product Compliance, Federal and Integrated Product Compliance, and External Audit teams, ensuring organizational readiness for regulatory oversight, driving enterprise-wide implementation of regulatory requirements, and promoting a culture of proactive compliance.