RN Care Manager - Baltimore - Hybrid - Mainly Remote Cityblock HealthRN Care Manager - Baltimore - Hybrid - Mainly RemoteMarylandRemoteUtilizes care facilitation tools, electronic health records, and scheduling platforms to gather data, document member interactions, organize information, track tasks, and communicate with team members and community resources. Develops a care plan in collaboration with the member, addresses social needs with the support of the Community Health Partner and supports members in achieving their care plan goals through coordinated and comprehensive care efforts.
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 / yearNext 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. Project Leadership: Manage the full lifecycle of complex IT systems development, software enhancements, or cloud migrations following the CMS eXpedited Lifecycle (XLC) framework or approved Agile methodologies.
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.
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.
RN Care Manager - Baltimore - Hybrid - Mainly Remote Cityblock Health IncRN Care Manager - Baltimore - Hybrid - Mainly RemoteBaltimore, MDRemote$95,000–$102,000 / yearMedical Clearance (for Member-Facing Roles): You must complete Cityblock's medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases. Utilizes care facilitation tools, electronic health records, and scheduling platforms to gather data, document member interactions, organize information, track tasks, and communicate with team members and community resources.
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.
NewSenior Quality Analyst (Remote) Blue Cross and Blue Shield AssociationSenior Quality Analyst (Remote)DCRemote$72,432–$143,858 / yearLead and support complex medical record retrieval, provider outreach, intake, routing, upload, documentation, abstraction, overread, quality review, and pend research activities for prospective and retrospective HEDIS projects, Stars initiatives, Risk Adjustment support, supplemental data validation, and other quality or regulatory initiatives. Experience monitoring productivity, quality, retrieval, abstraction, overread, outreach, pend management, or project trends to recommend workflow improvements, escalation, training, operational strategies, supplemental data validation, primary source verification, and audit-readiness workflows.
Clinical Navigator (Remote) Blue Cross and Blue Shield AssociationClinical Navigator (Remote)Baltimore, MDRemote$72,216–$143,429 / yearUtilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge.
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.
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 .
Associate Ambulatory Clinical Analyst-New Jersey Av-DC NO REMOTE Unity Health Care IncAssociate Ambulatory Clinical Analyst-New Jersey Av-DC NO REMOTEWashington, DCRemoteUnder the supervision of the Information Systems Clinical and Business Applications Manager, the Associate Ambulatory Clinical Analyst supports assigned Epic clinical applications and works closely with clinical, operational, and Information Technology teams to optimize healthcare technology and workflows. The analyst provides Tier 1/2 application support, assists with system upgrades and enhancements, resolves end-user issues, develops and maintains system documentation, and collaborates with stakeholders to improve clinical workflows and patient care delivery.
New100% Remote DLA BCAT Experience Must Tryfacta, Inc100% Remote DLA BCAT Experience MustFort Belvoir, VARemote$80–$100 / hourTryfacta is seeking a Task Order Project Manager Business Systems Testing for our client in Remote / Washington, DC Area Preferred . Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private & public sector firms across the US.
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)Fairfax, 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.
NewCustomer Service Representative I, Remote CSR MMC GroupCustomer Service Representative I, Remote CSRRemote in MD Preferred, MDRemote$18.50–$21.50 / hourThroughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
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.
Provider Credentialing Specialist I (Remote) Blue Cross and Blue Shield AssociationProvider Credentialing Specialist I (Remote)DCRemote$38,520–$70,620 / yearMaintains the provider file, the Provider Information Control (PICS) inventory workflow system and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Reimbursement Analyst (Remote) Blue Cross and Blue Shield AssociationReimbursement Analyst (Remote)DCRemote$53,928–$107,107 / yearQUALIFICATIONS: Education Level: Bachelor''s Degree in HealthCare Administration, Business Administration, Finance or related field OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience. PURPOSE: This position is responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers'' reimbursement fee levels.
Clinical Risk Manager (Remote) Sunrise Senior LivingClinical Risk Manager (Remote)McLean, VARemoteOperating as a key subject matter expert and advisor, this role collaborates closely with clinical staff, legal counsel and organization leadership to ensure compliance with healthcare regulations, reduce liability exposure and promote a culture of resident safety and risk awareness. The unique responsibilities for this role include but are not limited to the essential functions listed as follows: Manages ongoing analysis, development and implementation of methods and systems to improve the overall safety, efficiency and effectiveness of the Legal & Clinical Risk Management program.
Oracle/Cerner Millennium Consultant :: Washington DC (Remote) ARK Solutions, Inc.Oracle/Cerner Millennium Consultant :: Washington DC (Remote)Washington, DCRemoteCollaborate with interface teams to support lab interfaces and results routing. Support Oracle Cerner Millennium design/build validation activities.