Remote Healthcare administration Jobs • US

The Care Coordination Manager leads a team of Care Guides to ensure high-quality, person-oriented care for members navigating complex health and social needs. This role oversees operations, regulatory compliance, team development, training, and strategic alignment with organizational goals. Responsibilities include team leadership, program oversight, and ensuring quality and compliance.

We are seeking Texas barred Healthcare Attorneys to join our team and support our clients. This role offers an opportunity to work with a national healthcare organization. Responsibilities include advising clinical and operational leaders on legal, regulatory, and compliance issues, reviewing agreements, and supporting the development of compliant clinical operations policies.

The Director will oversee a distributed credentialing and compliance team, architect scalable workflows, and drive implementation of new technology solutions that elevate speed, accuracy, and regulatory compliance. This is a hands-on leadership role in a fast-paced, low-ego, high-output environment. Looking for a process-driven leader who thrives on building structure from complexity.

As an Investigative Clinician, you will blend clinical expertise with investigative acumen to detect, prevent, and resolve fraudulent, exaggerated, or non-medically necessary claims. You'll collaborate with adjusters, legal teams, and investigators to analyze medical documentation and uncover inconsistencies or red flags. Responsibilities include reviewing medical records, identifying patterns of fraud, providing clinical expertise, interviewing claimants, and preparing clinical summary reports.

Design and build a health plan from the ground up as an Clinical Appeals Coordinator. Reporting to the Health Plan Manager of Utilization Review, the Appeals Nurse, will be an integral member of the health plan’s medical management team. The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.

Serves customers by answering incoming calls utilizing Denver Health and Departmental policies/processes to resolve customer health information requests and directing calls to the appropriate area when necessary. Provides assistance to Denver Health staff by collecting demographic, medical complaint and key information required to facilitate appropriate patient care and call resolution. Educates customers on additional services by recognizing opportunities to enhance the customers' experience and meet their needs.

The Care Coordinator facilitates a team approach to ensure appropriate interventions and cost effective delivery of quality care and services across the continuum. This role collaborates with an interdisciplinary care plan team to address care issues, specific member needs and disease processes. It coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes.

In this remote role, the Clinical Data Analyst is responsible for coding and abstracting diagnoses and procedures from inpatient and outpatient medical records for optimal and timely reimbursement and quality reporting. The analyst will assign ICD-10-CM/PCS codes and DRGs for inpatient medical records accounts, as well as ICD-10-CM/PCS codes and CPT codes for outpatient medical record accounts.

This role helps NASTAD achieve its vision of a world committed to ending HIV/AIDS, viral hepatitis, and intersecting epidemics by strengthening and integrating public health and healthcare systems. The Manager will work closely with NASTAD members and health systems across the country to align HIV care and treatment. Responsibilities include technical assistance, generating data-driven insights, and creating custom solutions.

Be a part of a world-class academic health-care system at UChicago Medicine as an Emergency Department Coder in the Medical Records department. In this role, you will be responsible for coding and abstracting of diagnoses and charging for procedures from emergency department medical records for optimal and timely reimbursement and quality reporting.