Clinical Claim Review RN UnitedHealth Group IncClinical Claim Review RNBoston, MARemote$29–$52 / hourThe 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. The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment.
Assistant/Associate Professor of Practice & Clinical Simulation Learning Specialist Simmons UniversityAssistant/Associate Professor of Practice & Clinical Simulation Learning SpecialistBoston, MARemote$85,196–$116,716 / yearInterested candidates should submit the following electronically with their application: (1) a letter of application addressing teaching experiences, (2) teaching philosophy, course or content interests, and clinical/professional interests and expertise; and (3) curriculum vitae. Simmons is committed to creating, developing, promoting, and enhancing inclusive hiring practices-at all levels, for all positions-ensuring diverse talent pools and the delivery of a consistent positive candidate experience.
Nurse Practitioner, Compass Plus Program Brigham and Women's HospitalNurse Practitioner, Compass Plus ProgramSomerville, MARemote$126,838.40–$173,867.20 / yearThe program brings together providers, nurses, behavioral health specialists, and other care team members to deliver coordinated, patient-centered care focused on improving health outcomes, enhancing access to services, and supporting long-term health management. We are seeking a full-time, 40-hour Nurse Practitioner to join the Compass Plus team, caring for a panel of approximately 120 patients throughout the Northern Massachusetts region, including but not limited to Lawrence, Lowell, Peabody, and Newburyport.
Nurse Practitioner, Compass Plus Program Mass General BrighamNurse Practitioner, Compass Plus ProgramSomerville, MassachusettsRemoteThe program brings together providers, nurses, behavioral health specialists, and other care team members to deliver coordinated, patient-centered care focused on improving health outcomes, enhancing access to services, and supporting long-term health management. We are seeking a full-time, 40-hour Nurse Practitioner to join the Compass Plus team, caring for a panel of approximately 120 patients throughout the Northern Massachusetts region, including but not limited to Lawrence, Lowell, Peabody, and Newburyport.
RN Nurse Case Manager (Per Diem) Brigham and Women's HospitalRN Nurse Case Manager (Per Diem)Newton, MARemoteKey areas of responsibilities include managing day to day payer communication as it relates to supporting hospital admissions; providing UR to payers as needed; managing complex billing decisions; identifying payer trends; responding to payer denials; interfacing with other departments that impact billing and denials; educating care coordination staff about utilization management issues, government regulations and other things that impact revenue integrity; and providing reports related to UM as needed. The essential duties of the Insurance Support-Utilization Case Manager are to act as the department coordinator for all insurance workflows that case managers are responsible for; be the department point person for managing and preventing denials and the department expert for understanding payer rules and regulations.
Senior Clinical Quality Performance Specialist AmeriHealth CaritasSenior Clinical Quality Performance SpecialistManchester, NHRemoteManages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Role Overview: The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions.
Strategic Clinical Quality Manager - Minneapolis/St.Paul and surrounding areas - Minnesota Region Fresenius Medical CareStrategic Clinical Quality Manager - Minneapolis/St.Paul and surrounding areas - Minnesota RegionWaltham, MassachusettsRemoteThis role oversees clinical outcomes, coordinates quality initiatives, ensures adherence to regulations, and collaborates with the interdisciplinary team to drive continuous improvement in patient safety and clinical quality performance. Collaborate with physicians, nurses, dietitians, social workers, and leadership to support evidence-based clinical initiatives.
Bilingual (Spanish/English) Diabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist) Devoted Health IncBilingual (Spanish/English) Diabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist)Waltham, MARemote$80,000–$95,000 / yearComplete detailed assessments and continue following up with members in the Diabetes Clinic to complete ongoing education on all pillars of diabetes management (disease process, medications, glucose monitoring, lifestyle counseling, contingency planning). The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Clinical Educator Brigham and Women's HospitalClinical EducatorSomerville, MARemote$79,560–$115,720.80 / yearThis role has a strong focus on Utilization Management (UM) and Prior Authorization workflows, supporting evidence-based practice, regulatory compliance (CMS, NCQA), and operational excellence for teams involved in care coordination, case management, and UM review functions. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
NewSupervisor, Utilization Management Medicare and Duals (One Care and SCO) Brigham and Women's HospitalSupervisor, Utilization Management Medicare and Duals (One Care and SCO)Somerville, MARemote$99,465.60–$144,643.20 / yearWorking with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
NewDiabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist) Devoted Health IncDiabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist)Waltham, MARemote$80,000–$95,000 / yearComplete detailed assessments and continue following up with members in the Diabetes Clinic to complete ongoing education on all pillars of diabetes management (disease process, medications, glucose monitoring, lifestyle counseling, contingency planning). The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
NewDiabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist) Devoted Health ServicesDiabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist)MassachusettsRemoteComplete detailed assessments and continue following up with members in the Diabetes Clinic to complete ongoing education on all pillars of diabetes management (disease process, medications, glucose monitoring, lifestyle counseling, contingency planning). The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
NewBilingual (Spanish/English) Diabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist) Devoted Health ServicesBilingual (Spanish/English) Diabetes Educator - Clinical Guide(Certified Diabetes Care and Education Specialist)MassachusettsRemoteComplete detailed assessments and continue following up with members in the Diabetes Clinic to complete ongoing education on all pillars of diabetes management (disease process, medications, glucose monitoring, lifestyle counseling, contingency planning). The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Hybrid Remote BCBA Center for Social Dynamics IncHybrid Remote BCBAPuyallup, WARemote$87,000–$102,000 / yearWe've rebalanced service minimums to deliver greater flexibility, sustainable workloads, and real ownership over earning potential, while launching breakthrough clinical programs that strengthen outcomes for both families and clinicians. Stability & Innovation - Our model balances long‑term stability with thoughtful innovation, supporting clinicians with sustainable growth and evolving modalities that enhance clinical care - not disrupt it.
NewSenior Oncology Account Manager (OAM) - West Region-Remote-Seattle, Washington Ideaya Biosciences IncSenior Oncology Account Manager (OAM) - West Region-Remote-Seattle, WashingtonSeattle, WARemote$187,000–$231,000 / yearNon-Solicitation Policy and Notice to Agencies and Recruiters: IDEAYA's Non-Solicitation Policy strictly prohibits agencies and recruiters from any contact and communication with IDEAYA employees, managers, and leaders to submit unsolicited candidate resumes and/or to solicit business partnerships. The final salary offered to a successful candidate will depend on several factors that may include but are not limited to the office location where this open position is located, the final candidates' experience within their profession, experience in the disease areas we are striving to make an impact in as a company, length of time within the industry, educational background, and performance during the interview process.
Account Executive (Remote, U.S. — West Coast) FusionAuthAccount Executive (Remote, U.S. — West Coast)Seattle, WARemoteBenefits For full-time team members, we offer: Comprehensive health insurance including medical, dental, and vision coverage, with the company covering the majority of your medical premiums to keep your costs low Fully employer-paid High Deductible Health Plan (HDHP) option paired with a Health Savings Account (HSA), including employer contributions. Since our target customers are often technical (CTOs, Platform Engineers, Developers, and CISOs), nearly all sales engagements will involve technical questions and deep technical discovery.
NewCSR I Operations (Temporary, Remote McAllen, TX) MaximusCSR I Operations (Temporary, Remote McAllen, TX)Seattle, WARemoteFull timeEssential Duties and Responsibilities: - Provides customer service for basic and routine inquiries and problems via multiple possible channels (i.e. telephone, emails, web chats, or written letters). If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com .
Physician - Radiologist - Teleradiology/Radiology - 1099 - Remote - 4-9hr shift Options MedAtlantic Healthcare SolutionsPhysician - Radiologist - Teleradiology/Radiology - 1099 - Remote - 4-9hr shift OptionsSeattle, WashingtonRemoteMedAtlantic Healthcare Solutions has partnered with a growing teleradiology group that is looking for a General teleradiologist to join their practice reading 100% remotely from home. If you’re not interested but have a colleague who might be, MedAtlantic offers a lucrative referral bonus if you refer a colleague that would like more information.
Data Entry Assistant (Remote) Easy RecruiterData Entry Assistant (Remote)Seattle, WashingtonRemoteObtain pertinent medical records from providers (Hospitals, Nephrology, Home Health agencies) and manage scan information within the care management platform. Appropriately and accurately verify and process requests for charts to be pulled for patient care, quality review, and audits in a timely manner.
Clinical Registrar - Tumor Registry - Remote Providence St. Joseph HealthClinical Registrar - Tumor Registry - RemoteSpokane, WARemoteTogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.