Clinical Quality Specialist HealthfirstClinical Quality SpecialistNew York, NY$68,900–$99,620 / yearThe Clinical Quality Specialist is responsible for performing Healthcare Effectiveness Data and Information Set (HEDIS) medical record review, supplemental data validation, data abstraction, and clinical data quality activities using internal and external clinical data sources. The specialist works collaboratively with providers, vendors, and internal departments to ensure compliance with NCQA, CMS, state, and organizational requirements while supporting data integrity and audit readiness.
Surgical Coordinator - Orthopedics - Health and Wellness Center Hackensack University Medical CenterSurgical Coordinator - Orthopedics - Health and Wellness CenterClark, NJThe posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. A day in the life of a Surgical Coordinator at Hackensack Meridian Health includes: Coordinates all aspects of tests, procedures and surgeries under the direction and supervision of the Practice Supervisor or Manager and physician(s) in an efficient manner.
Clinical Documentation Expert - Fully Remote MercorClinical Documentation Expert - Fully RemoteNew York, New YorkRemoteMonitor CDI program KPIs, including query response rates, CC/MCC capture rates, case mix index, and DRG accuracy. 5+ years of experience in clinical documentation integrity or improvement, with 2+ years in a manager or leadership role.
Decision Scientist - Clinical Informatics (Clinical Data Standards) CVS Health CorpDecision Scientist - Clinical Informatics (Clinical Data Standards)NJ$64,890–$158,620 / yearA&BC leverages advanced analytics, clinical informatics, and hypothesis-driven approaches to transform data into actionable, customer-centric insights that drive growth, improve health outcomes, and expand access to healthcare across all CVS Health businesses. Collaborate with data engineering teams to inform data pipeline development, ensuring clinical data is ingested, transformed, and stored in ways that support downstream analytics needs.
CDI Leader - Clinical Documentation MercorCDI Leader - Clinical DocumentationNew York, New YorkRemoteMonitor CDI program KPIs, including query response rates, CC/MCC capture rates, case mix index, and DRG accuracy. 5+ years of experience in clinical documentation integrity or improvement, with 2+ years in a manager or leadership role.
Billing Services Representative Saint Peter's Healthcare System IncBilling Services RepresentativePiscataway, NJReview outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances. Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.).
NewMDS Coordinator Sunrise Senior Living ServicesMDS CoordinatorEdison, New Jersey$41–$56.65 / hourWhat You’ll Do: • Coordinate and complete MDS, CAA and Care Plans per federal and state regulations • Maintain MDS schedules and ensure timely, accurate submissions • Facilitate Triple Check and weekly Medicare meetings • Review clinical documentation for accuracy and reimbursement support • Ensure Care Plans are individualized and aligned with resident goals • Monitor Quality Indicators and analyze CASPER/iQIES reports • Participate in IDT and QAPI meetings to drive quality improvement • Provide MDS and documentation training to clinical team members • Support ICD-1 coding accuracy and skilled services documentation • Collaborate with Business Office to ensure timely billing Resident Assessment Coordinator (RN/LPN) – Lead MDS Accuracy and Drive Quality Care Outcomes MDS Coordinator | Resident Assessment Coordinator | RN | LPN | Skilled Nursing | Care Planning | RAI. The Resident Assessment Coordinator (RAC) leads the Resident Assessment Instrument (RAI) process for Skilled Nursing, ensuring accurate MDS completion, individualized care planning and regulatory compliance.
Surgical Coordinator - Orthopedics - Health and Wellness Center Hackensack Meridian HealthSurgical Coordinator - Orthopedics - Health and Wellness CenterClark, New JerseyFull timeThe posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. Responsibilities: A day in the life of a Surgical Coordinator at Hackensack Meridian Health includes: Coordinates all aspects of tests, procedures and surgeries under the direction and supervision of the Practice Supervisor or Manager and physician(s) in an efficient manner.
Wound Care Nurse - Lpn-Lvn - Full Time Project RestorixWound Care Nurse - Lpn-Lvn - Full TimeRahway, NJWhat You'll Do: Provide patient care based on scientific principles/nursing theory and evidence-based practiceImplement physician orders accurately within appropriate time framesRecognize change in the patient's condition and intervene appropriatelyPrioritize nursing actions including reflecting patient needs, acuity, and desired outcome. Qualifications: Valid LPN nursing license requiredValid CPR certification from the American Heart Association requiredPrior experience working with wound care patients preferred (Will train)Experience with billing and coding preferred.
Lead Software Engineer - AI Humana IncLead Software Engineer - AINew York, NY$129,300–$177,800 / yearExercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Clinical and Product Partnership: Collaborate closely with product managers, designers, clinicians, and data stakeholders to understand care delivery workflows and translate them into well-scoped, high-impact AI features.
Clinical Data Specialist Richmond Medical CenterClinical Data SpecialistStaten Island, New YorkDay Shift - 7.5 Hours (United States of America) The Clinical Data Specialist (Coder) codes hospital records for the purpose of reimbursement, research and compliance with federal regulations according to diagnosis, operations and procedures using ICD-10-CM classification system. If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
NewAppeals Specialist GeneDX LLCAppeals SpecialistCranbury, NJRemote$31.25–$33.65 / hourGeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world's largest, rare disease data sets. The Appeals Specialist is responsible for reviewing denied claims, identifying root causes, and submitting well-documented appeals to maximize reimbursement for specialized laboratory services.
Medical Director - ENT CVS Health CorpMedical Director - ENTNJ$174,070–$374,920 / yearLeads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Clinical Documentation Specialist - CDI MercorClinical Documentation Specialist - CDINew York, New YorkRemote$50–$150 / hourComfort working inside CAC/CDI software and reading the full clinical record, including H&Ps, consults, progress notes, discharge summaries, labs, and flowsheets. Ensure codes are changed, queries sent, holds placed, DRG recomputed, and notes and CDI reviews filed.
Senior Architect, Data Engineering West Monroe Partners, LLCSenior Architect, Data EngineeringNew York, NY$199,100–$223,400 / yearThis is an excellent opportunity to work with clients developing Big Data strategy and roadmaps, while gaining exposure to a variety of industries including Healthcare, Financial Services, Insurance, Consumer & Industrial Products, and Energy & Utilities. Proven experience in supporting business development efforts, including identifying client needs, crafting technical solutions, contributing to proposals, and participating in pre-sales activities to drive revenue growth.
Dental Practice Manager The SmilistDental Practice ManagerStaten Island, NY$75,000–$80,000 / yearAbout Us: We are seeking a dynamic and experienced practice manager for our Staten Island Dental Practice who excels at leadership, team development, and business operations in a high-end, fast-paced environment. Develop and execute marketing strategies to attract new patients and retain current ones, including managing the practice’s online presence, social media, and local advertising.
Resident Assessment Coord. Sunrise Senior Living LLCResident Assessment Coord.Edison, NJWhat You'll Do: • Coordinate and complete MDS, CAA and Care Plans per federal and state regulations • Maintain MDS schedules and ensure timely, accurate submissions • Facilitate Triple Check and weekly Medicare meetings • Review clinical documentation for accuracy and reimbursement support • Ensure Care Plans are individualized and aligned with resident goals • Monitor Quality Indicators and analyze CASPER/iQIES reports • Participate in IDT and QAPI meetings to drive quality improvement • Provide MDS and documentation training to clinical team members • Support ICD-1 coding accuracy and skilled services documentation • Collaborate with Business Office to ensure timely billing Resident Assessment Coordinator (RN/LPN) - Lead MDS Accuracy and Drive Quality Care Outcomes MDS Coordinator | Resident Assessment Coordinator | RN | LPN | Skilled Nursing | Care Planning | RAI. The Resident Assessment Coordinator (RAC) leads the Resident Assessment Instrument (RAI) process for Skilled Nursing, ensuring accurate MDS completion, individualized care planning and regulatory compliance.
Software Engineer (Finch Legal, New York, NY) FinchSoftware Engineer (Finch Legal, New York, NY)New York City, New York$180,000–$280,000 / yearWe believe the best outcomes happen when expert operators and purpose-built AI work together – which is why we handle every step of pre-lit, from intake and claim opening to medical records, lien management, and demands, with humans leading every case. Requires a Bachelor's degree or foreign equivalent in Computer Science or related field, and at least two years of experience as a Software Engineer or related occupation.
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DONJ$174,070–$374,920 / yearThe Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases.
Wound Care Nurse - RN - PRN Project RestorixWound Care Nurse - RN - PRNSomerville, NJWhat You'll Do: Provide patient care based on scientific principles/nursing theory and evidence-based practiceRecognize change in the patient's condition and intervene appropriatelyPrioritize nursing actions including reflecting patient needs, acuity, and desired outcomesImplement physician orders accurately within appropriate time framesEducate and counsel patients and their families on wound care processes and issues. Qualifications: Associate degree in nursing, Bachelor of Science in Nursing required for Magnet HospitalsValid Registered Nursing license requiredValid CPR certification from the American Heart Association requiredPrior experience working with wound care patients (Will train)Prior experience with billing and coding preferred.