Manager, Medical Utilization and Care Management Capital Rx LLCManager, Medical Utilization and Care ManagementNew York, NY$95,000–$130,000 / yearJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi 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. Oversee vendor execution of utilization reviews, including prospective, concurrent, and retrospective reviews, to ensure medical necessity and appropriate level of care determinations.
Facility-Fee Emergency Department Medical Coder Sutherland GlobalFacility-Fee Emergency Department Medical CoderClifton, NJThe Facility-Fee Emergency Department Medical Coder is responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. The coder will review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits.
Clinical Research Associate, Full Time Days 8a-4p, Atlantic Health, Morristown Medical Center Atlantic Health System IncClinical Research Associate, Full Time Days 8a-4p, Atlantic Health, Morristown Medical CenterMorristown, NJAtlantic Health scored four A grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm. Morristown Medical Center is a Magnet Hospital for Excellence in Nursing Service, the highest level of recognition achievable from the American Nurses Credentialing Center for facilities that provide acute care services.
Medical Case Manager Crawford & CoMedical Case ManagerNew Jersey, NJReviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual''s medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
Medical Coder - Inpatient (DRG Reviewer) Acentra HealthMedical Coder - Inpatient (DRG Reviewer)NY$29.19–$36 / hourMinimum of 2 years of progressive hands-on experience in acute care inpatient coding, clinical documentation improvement (CDI), medical scribing, DRG auditing/review, or related healthcare documentation experience. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Certified Medical Assistant Vanova HealthCertified Medical AssistantRandolph, New Jersey$19–$25 / hourFull timeKey responsibilities include preparing patients for examinations, obtaining and documenting vital signs and medical histories, assisting providers with procedures, administering injections and vaccinations (as permitted by certification and state regulations), performing point-of-care testing, coordinating patient flow, maintaining accurate medical records, and ensuring exam rooms are stocked and prepared. Vanguard Medical Group is committed to fostering professional growth, supporting work-life balance, and creating an environment where team members can build rewarding careers while delivering outstanding care to the community.
Medical Scribe (Bilingual Spanish Required) Oak Street HealthMedical Scribe (Bilingual Spanish Required)New York, NY$17–$34.15 / hourScribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. This is an excellent opportunity for pre-med track individuals looking to gain practical, paid experience in a clinical setting before applying to an MD/DO/PA/NP program, as well as those pursuing careers in Health Informatics, Public Health, Healthcare Administration, Medical Coding, and other related fields.
Registered Nurse; Oncology Data Coordinator - Immune Effector Cellular Therapy (IEC) Program- Part Time, Days, 7 PM - 7 AM Hematology Oncology Atlantic Health Morristown Medical Center Atlantic Health System IncRegistered Nurse; Oncology Data Coordinator - Immune Effector Cellular Therapy (IEC) Program- Part Time, Days, 7 PM - 7 AM Hematology Oncology Atlantic Health Morristown Medical CenterMorristown, NJThis role ensures the accurate and timely submission of required data to the Center for International Blood & Marrow Transplant Research (CIBMTR), FACT/JACIE accreditation bodies, regulatory agencies, and institutional quality programs. Atlantic Health scored four "A" grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm.
Physician Associate Director of Medical Operations ConcentraPhysician Associate Director of Medical OperationsRahway, New Jersey$249,618.72–$356,252 / yearThis position is eligible to earn a base compensation rate in the range of $249,618.72 to $356,252.00 annually depending on job-related factors as permitted by applicable law, such as level of experience, geographic location where the work is performed, and/or seniority. Excellent communication skills including speaking, presentation, listening, telephone, negotiation, business and medical writing skills necessary to convey information to supervisors, peers, or customers.
HEDIS Quality Auditor # 26-21590 US Tech Solutions, Inc.HEDIS Quality Auditor # 26-21590Newark, NJ$40–$45 / hourUS Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. Job Description: This position is responsible for conducting quality audits for state audits, HEDIS and quality referral and complaints issues.
HEDIS Data Analytics Consultant Contech SystemsHEDIS Data Analytics ConsultantNew York, NYRemote$60–$70 / hourThis role partners with Clinical Quality, Population Health, IT, EHR vendors, data aggregators, and HEDIS software vendors to manage large healthcare datasets, automate data ingestion and validation, support Medical Record Review (MRR) activities, and ensure compliance with annual NCQA HEDIS requirements. Investigate data quality, ingestion, and integration issues; perform root cause analysis of HEDIS rate variances; and coordinate corrective actions with IT, vendors, and business stakeholders.
Associate Manager - Community Health Worker - Work at Home CVS Health CorpAssociate Manager - Community Health Worker - Work at HomeNJ$88,374–$190,344 / yearThe Associate Manager will lead the implementation, oversight, and ongoing management of the Community Health Worker (CHW) Pilot focused on addressing health disparities and improving outcomes among Medicaid members with Type 2 diabetes or other chronic diagnoses. The Associate Manager will oversee CHW staff, ensure alignment with interdisciplinary care teams, and drive achievement of pilot goals, including improved self-management, enhanced member experience, and measurable improvements in quality and utilization metrics.
Senior Quality Improvement Specialist, Clinical (Registered Nurse) VNS HealthSenior Quality Improvement Specialist, Clinical (Registered Nurse)New York, NY$93,400–$116,800 / yearWe'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. Collaborates across departments-including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics-to sustain continuous improvement, advance health equity, and ensure regulatory readiness.
Senior Quality Improvement Specialist, Clinical (Registered Nurse) | Hybrid – 3 Days Onsite VNS HealthSenior Quality Improvement Specialist, Clinical (Registered Nurse) | Hybrid – 3 Days OnsiteNew York, New York$93,400–$116,800 / yearFull timeCollaborates across departments—including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics—to sustain continuous improvement, advance health equity, and ensure regulatory readiness. Performs clinical reviews with network providers to validate diagnoses, address care gaps, and support accurate HEDIS/QARR documentation.
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.
RN, Community Based Care Management Hackensack Meridian HealthRN, Community Based Care ManagementEdison, New JerseyFull timeResponsibilities: A day in the life of a RN, Community Based Care Management at Hackensack Meridian Health includes: Effective provides/facilitates the following education & advocacy support: Education: Complete needs assessment, formulate and carry out a comprehensive teaching program -Promotes patient engagement, self-management, and shared decision making -Establishes relationship with patients and caregiver, if any -Translate care choices and treatment plans. Identify high-risk patients, assess clinical and psychosocial needs, make referrals to ancillary providers (disease management, pharmacy, social work, palliative care, community-organizations, non-clinical services), develop care plan in coordination with PCP, engage and activate patients.
Licensed Practical Nurse Actalent IncLicensed Practical NurseGreenwich, CT$31.25–$38.50 / hourThe LPN supports ambulatory primary care and specialty clinics, promotes continuity of care, and contributes to quality and population health initiatives in a nonprofit environment that delivers health, education, and human services across Fairfield County. The organization provides comprehensive primary healthcare, dental, and mental health services to children and adults in Greenwich and Stamford, with a special focus on individuals and families living in or near public housing.
Lead Analyst, Digital HEDIS & Quality Analytics - (Remote) EmblemHealth IncLead Analyst, Digital HEDIS & Quality Analytics - (Remote)New York, NYRemote$77,760–$149,040 / yearBachelor's Degree in analytical/quantitative field including healthcare management, finance, business, mathematics, engineering, applied stats/economics, or any other related fields. Advanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources (Required).
Sr. Analyst, Digital HEDIS & Quality Analytics - (Remote)/2 positions available EmblemHealth IncSr. Analyst, Digital HEDIS & Quality Analytics - (Remote)/2 positions availableNew York, NYRemote$68,040–$118,800 / yearAdvanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources (Required). Bachelor's Degree in analytical/quantitative field including healthcare management, finance, business, mathematics, engineering, applied stats/economics, or any other related fields.
Advanced Practice Clinician (Bilingual Chinese required) VNS HealthAdvanced Practice Clinician (Bilingual Chinese required)Brooklyn, New York$109,900–$146,500 / yearFull timeManages and provides comprehensive, advanced nursing care, including post-discharge aftercare visits, annual comprehensive assessment visits, palliative care-care management program onboarding, and change in condition assessment visits (including physical examination, comprehensive history, screening for physical and/or psychological conditions, and point of care testing). Provides care in one or more care settings based on the clinical requirements: virtually, telephonically or travels to patients’ homes and/or other facilities with varying environments (e.g., elevated buildings, walk-ups, care facilities, single/multiple family homes, presence of pets, etc.) using approved transportation options.