Healthcare Senior Data Analyst Consultant, Payment Model Implementation (CMMI) - Remote UnitedHealth Group IncHealthcare Senior Data Analyst Consultant, Payment Model Implementation (CMMI) - RemoteWashington D.C., DCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Optum Serve Consulting/The Lewin Group (OSC/Lewin), a premier national health care and human services consulting and policy analysis firm, brings 50 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors.
Healthcare Senior Data Analyst Consultant, Quality Measurement (CMMI) - Remote UnitedHealth Group IncHealthcare Senior Data Analyst Consultant, Quality Measurement (CMMI) - RemoteWashington D.C., DCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Optum Serve Consulting/The Lewin Group (OSC/Lewin), a premier national health care and human services consulting and policy analysis firm, brings 50 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors.
Fraud AI / Data Healthcare Senior Consultant (remote) Guidehouse IncFraud AI / Data Healthcare Senior Consultant (remote)McLean, VARemote$113,000–$188,000 / yearHands-on experience with financial crime compliance technology and data solutions, e.g., Oracle Mantas, Actimize, Fircosoft, LexisNexis Bridger, World-Check, Dow Jones, Chainalysis, Elliptic, TRM Labs, etc. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
NewSolutions Architect (Healthcare Payer and PBM Operations) MindlanceSolutions Architect (Healthcare Payer and PBM Operations)Baltimore, MDRemote3 Healthcare Payer and PBM Operations: Deep knowledge of and experience with health insurance and Pharmacy Benefit Management (PBM) business models, processes, capabilities, and supporting information systems, including pharmacy benefit design, formulary management, drug pricing, pharmacy networks, eligibility, claims, rebates, utilization management, specialty pharmacy, and member/provider services. 4. Pharmacy Benefit Administration: Strong understanding of the end-to-end pharmacy benefit lifecycle, including benefit configuration, formulary and drug list management, prior authorization, step therapy, quantity limits, accumulator management, specialty drugs, pharmacy network administration, claims adjudication, reversals, coordination of benefits, and payment/reconciliation.
Commercial & Healthcare Regulatory Counsel Alto IncCommercial & Healthcare Regulatory CounselMDRemote$135,000–$185,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. Issue-spot and provide practical guidance on applicable laws and regulations, such as the Anti-Kickback Statute (AKS), Stark Law, False Claims Act, FDA/DEA requirements relevant to pharmacy and telehealth operations, state pharmacy/professional licensing, PBM contracting/network participation, and HIPAA/HITECH.
NewHealthcare Ins Contact Admin RadNetHealthcare Ins Contact AdminMarylandRemote$30–$35 / hourFull timeWorks collaboratively with the Regional Directors of Contracting, Operations and Credentialing departments to maintain/update the RadNet East Coast Facility List, (sometimes referred to as the “Source of Truth” draft/distribute the corresponding payor notifications, document correspondent received from the payer and performs follow up to ensure the updates have been completed in the payor systems. Job Summary: Under minimal supervision, assists the Contracting and Payor Relations team, the Reimbursement Operations team and the authorization team in a support role handling departmental projects as assigned, facilitating communications to and from insurance companies, and internal/external contacts regarding updates on physician staff and facility information.
NewHealthcare Ins Contact Admin RadNet IncHealthcare Ins Contact AdminMaryland, MDRemote$30–$35 / hourWorks collaboratively with the Regional Directors of Contracting, Operations and Credentialing departments to maintain/update the RadNet East Coast Facility List, (sometimes referred to as the "Source of Truth" draft/distribute the corresponding payor notifications, document correspondent received from the payer and performs follow up to ensure the updates have been completed in the payor systems. Job Summary: Under minimal supervision, assists the Contracting and Payor Relations team, the Reimbursement Operations team and the authorization team in a support role handling departmental projects as assigned, facilitating communications to and from insurance companies, and internal/external contacts regarding updates on physician staff and facility information.
NewManager, Healthcare Sales Illumina IncManager, Healthcare SalesVARemote$129,400–$194,000 / yearTo ensure a high level of liaison with other departments (e.g., Marketing, Customer Solutions) and local sales team & staff to ensure coordination of activities and understanding of common goals. Additionally, all employees are eligible for one of our variable cash programs (bonus or commission) and eligible roles may receive equity as part of the compensation package.
Healthcare Programmer, Medicaid and Pharmacy American Institutes for ResearchHealthcare Programmer, Medicaid and PharmacyArlington, VARemote$130,000–$160,000 / yearOur team of experts-economists, data scientists, statisticians, public health experts, sociologists, nurses, physicians, and psychologists - advance evidence and save lives by leading rigorous research and evaluation; program implementation and monitoring; results-driven technical assistance and training; and leading-edge data science and technology tools. About AIR: Founded in 1946 and headquartered in Arlington, Virginia, the American Institutes for Research (AIR) is a nonpartisan, not-for-profit organization that conducts behavioral and social science research and delivers technical assistance to address some of the most pressing challenges in the United States and globally.
Healthcare Planner Royal Oak MI AHU Technologies IncHealthcare Planner Royal Oak MIWashington, DCRemoteFull timeThis role acts as a key liaison between healthcare clients, clinical staff, and design teams to ensure efficient, patient-centered, and code-compliant facility planning. This role offers high visibility and direct involvement in healthcare strategy, facility planning, and clinical operations alignment across complex healthcare projects.
Pm-080426 - Senior IT Project Manager - Healthcare IT Programs Next Phase Solutions and Services, Inc.Pm-080426 - Senior IT Project Manager - Healthcare IT ProgramsColumbia, MDRemote$135,000–$165,000 / yearWe are looking for a leader who takes ownership, anticipates challenges before they become roadblocks, builds trusted relationships with stakeholders, and consistently delivers high-quality outcomes in complex healthcare IT environments. Next Phase leadership is looking for new leaders, scientific and technical subject matter experts, and technically savvy people interested in putting forth the effort and commitment needed to grow our company.
Senior Test Lead - Healthcare Payer Claims & GenAI Cognizant Technology Solutions CorpSenior Test Lead - Healthcare Payer Claims & GenAIRockville, MDRemote$71,100–$112,500 / yearOur deep industry, process and engineering expertise enables us to build an organization's unique context into technology systems that amplify human potential, drive tangible outcomes and keep global enterprises ahead in a fast-changing world. 10+ years of strong Healthcare Payer domain expertise, including Claims Adjudication, Payment Integrity, Reimbursement & Pricing Validation, Provider Network Validation, Eligibility Determination, and Claims Lifecycle Processing.
NewDirector, Engineering - AI-First Healthcare Transformation Humana IncDirector, Engineering - AI-First Healthcare TransformationWashington, DCRemote$172,200–$236,900 / yearWork at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. We''re seeking a Director of Engineering to lead the AI-first transformation of our clinical technology organization, embedding AI-assisted engineering, agentic workflows, and modern data platforms directly into how we build, test, and deliver enterprise healthcare systems.
Sr. Data Engineer - Healthcare Zp Group LlcSr. Data Engineer - HealthcareWashington, DCRemote$160,000–$180,000 / yearThis position is ideal for an experienced engineer with strong expertise in AWS, Databricks, data modeling, and healthcare data environments who is excited to influence the future state of a rapidly evolving data ecosystem. The Senior Data Engineer will be responsible for designing and developing robust data pipelines, integrating enterprise systems, and helping establish the organization''s data warehouse architecture from the ground up.
Director, Staffing Transformation & Operations - Remote Included HealthDirector, Staffing Transformation & Operations - RemoteWashington DC, DCRemote$186,360–$229,779 / yearReporting to the Head of Member Care Strategy & Operations, you will partner closely with Member Care Advocacy (our member-facing teams), Staffing Forecasting, Quality, Training, Project Management, Finance, Product, Engineering, IT and vendor partners to turn strategic priorities into an operating model that works in production. You will directly oversee workforce management and scheduling functions (skilling, staffing, scheduling, and real‑time management) and vendor/BPO operations, ensuring we consistently meet or exceed service level, quality, and margin goals while delivering a top-notch member and employee experience.
Medicaid Economics Data Analyst - Full Time - Remote Role GD ResourcesMedicaid Economics Data Analyst - Full Time - Remote RoleSterling, VARemoteData Analyst III – Medical Economics Location: Fully Remote (CST/EST preferred; CA candidates must start ~6:00am PST) Type: Permanent Salary: $85,000–$95,000 base + 8% target bonus Industry: Healthcare / Managed Care Overview We are expanding our Medical Economics team and are seeking a Data Analyst III with strong managed care analytics experience. Required Qualifications Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance, or related field Equivalent experience considered .
Sr. Healthcare Partnerships Associate (Mid-Atlantic) Path CCM, IncSr. Healthcare Partnerships Associate (Mid-Atlantic)DCRemoteAs part of our team, full-time employees receive: 100% remote work environment: Working hours to support a healthy work-life balance, ensuring you can meet both professional and personal commitments (must be based in United States, currently not hiring in Hawaii). Must currently reside in the designated target market (no relocation assistance provided) with personal, reliable transportation to support up to 50% local travel within a 2-hour radius of Pennsylvania, Maryland, Delaware, Washington, D.C. and Virginia.
Care Coordinator for LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA) Sentara Healthcare IncCare Coordinator for LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA)Springfield, VARemoteWe offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. The position requires in person/face-to-face assessments with remote/home office for the LTSS Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas!
Vice President, Commercial Strategies and Initiatives (Remote) Aledade IncVice President, Commercial Strategies and Initiatives (Remote)Arlington, VARemoteIf you are a visionary healthcare strategist looking to lead high-performing teams, scale transformative products across independent primary care practices, and directly influence how care is delivered at scale, this role offers an unmatchable opportunity to make a lasting impact. Strategic Initiative Leadership & Operational Execution: Lead the end-to-end operationalization and scaling of core strategic initiatives, specifically focusing on the deployment, integration, and optimization of Aledade Complete and Patient Choice Services.
Director of Sales Engineering & Effectiveness, Remote Aledade IncDirector of Sales Engineering & Effectiveness, RemoteArlington, VARemoteThe Director will lead, coordinate and assign Deal support / customization for key accounts to the Sales Engineers; collaborate with Marketing team to inform segment specific campaigns and share learnings; evaluating ACO performance and assessing ROI and sales performance of initiatives using Salesforce CRM and other workflow and analytical tools. This leader is a strong operator & manager of SMEs foremost, able to run cross-functional weekly meetings, performance reviews, plus manage special projects & deliverables for executives, particularly GEL("Growth Executive Leadership" team) & Glue.