Transform complex healthcare policy into intelligent, automated logic that powers Rialtic’s payment accuracy engine, creating high-impact claims editing rules that help leading payers reduce overpayments and promote transparent, accurate reimbursement practices. This is a high-autonomy, high-impact role for someone who thrives in a collaborative, cross-functional environment and is eager to deepen their technical expertise while shaping a modern healthcare platform.
The Director, Diagnostic Imaging / Imaging Services provides strategic and operational leadership for all diagnostic imaging services across the organization, with a particular focus on echocardiography and ultrasound services. This remote leadership role oversees planning, development, coordination, quality assurance, and evaluation of imaging services. The Director ensures clinical excellence, regulatory compliance and alignment with organizational goals.
The Utilization Management Specialist (UMS) screens patients to determine the appropriate level of care through the use of clinical criteria, the Medicare Inpatient Only List, and individual payer requirements. The Utilization Management Specialist collects data, completes audits, and generates reports based on trends and various improvement initiatives. The Utilization Management Specialist interacts with Care Coordination, Coding, Revenue Integrity, Compliance, Physician Advisors, Physicians, and payers to establish level of care.
Provides oversight of network strategies and relationship development activities for assigned providers including individualized planning, training and development of providers to align with Presbyterian’s clinical quality initiatives. Will provide the framework for physician/provider performance reporting that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan.
Under general supervision, the Coder is responsible for reviewing applicable documentation and assigning appropriate procedure and diagnosis codes. Reviews notations, diagnosis, or procedure information in medical record to assign appropriate diagnosis and procedure codes, ensuring accuracy and appropriateness of codes. Ensures documentation supports the level and type of service billed in compliance with billing regulations, provider documentation, procedures and coding guidelines.
This role is a critical member of the SRH team. The Senior Associate will support the day-to-day operations of a small-grants funding mechanism that supports rapid deployment of funds for reproductive health products across low- and middle-income countries. They will support the overall coordination, implementation, and maintenance of a range of activities that underpin the pre-award and post-award life cycle of grant investments.
The Clinical Services Consultant is a highly skilled RN leader responsible for providing interim clinical leadership across agency locations. This role involves supporting or temporarily managing all or part of the Director of Clinical Services/Area Director role remotely and on-site, ensuring high-quality patient care, regulatory compliance, and operational excellence. When not deployed, the consultant engages in clinical leadership projects, training, and strategic initiatives.
The SVP & Head of Payor Solutions will lead the development, implementation, and growth of Mindoula's programs and partnerships with health plans and managed care organizations. This leader will ensure operational excellence, scalable growth, and optimal outcomes for payor-driven programs while collaborating closely with internal teams and external partners to advance Mindoula's mission, deliver measurable ROI, and improve health outcomes for complex populations.
The Director, Physician Activation is responsible for ensuring physicians in contracted groups refer patients to the CCP program. The Director works with a team of high-performing Clinical Partnership Managers (CPMs) who are assigned to specific physician groups/accounts/practices. The Director will establish and refine goals around referral volume and hold team members accountable to these goals.
Showcase your customer service and related data entry skills as part of Sutherland's healthcare team. You may be involved in claims adjudication and/or provider credentialing and will support customers by phone, email and chat, depending upon program and position. Join Sutherland to contribute to seamless, personalized, and efficient customer experiences.