Lead platform strategy and delivery across Authorizations, Medical Necessity, and Notice of Admission (NOA). Shape our FHIR interoperability roadmap, driving product modernization, and aligning with CMS mandates and TEFCA plans. Modernize legacy infrastructure into scalable, API-driven services. Play a critical role in business development, identifying and pursuing strategic partnerships, supporting M&A evaluations, and representing the product vision.
The Utilization Management Representative will process clinicals to send to payers while the patient is in house, enter authorizations and enter concurrent denials for the RNs. During your 8hr shift you will work with your team to manage the phone queue. A separate workspace, separate from noise between 8:30am-5pm AZ time will be required.
Leads and collaborates with care management operations across various settings, ensuring alignment with system-level strategies. Oversees multiple disciplines, working with medical staff, nursing, clinical, and revenue cycle leaders to optimize patient care and financial performance. Responsible for managing departmental services, including social work, complex care planning, transitions of care, and utilization management.
As the Manager, Provider Engagement, East you will lead the Provider Engagement team to drive network growth, strengthen provider relationships, and ensure Imagine Pediatrics meets enrollment and performance goals. This role requires a balance of team leadership, hands-on process improvement, and relationship management.
Seeking a proactive and detail-oriented team member to help keep our clinician payer enrollment process moving smoothly. You will submit payer enrollments, track statuses, follow up with payers to resolve blockers, and request fee schedules to support operational planning, ensuring clinicians are paneled quickly, especially in NY, NJ, CA, TX, FL, PA, and CO.
Our client, a national healthcare organization, is seeking an experienced Senior Clinical Coding Auditor & Trainer to support its inpatient-coding audit and training initiatives. This role combines coding precision, clinical expertise, and the ability to teach and mentor. The right candidate will develop audit tools, deliver training, and ensure compliance standards are met across a multi-state managed-care operation.
The ECM Clinical Manager handles clinical oversight and management of ECM Lead Care Managers in addressing client's medical, behavioral health, and social determinants of health needs. This role involves communication with ECM Lead Care Managers and occasionally with patients to discuss medication management and ensure follow-up with healthcare providers. The ECM Clinical Manager will be required to travel to Los Angeles, CA, on a monthly basis for up to one week.
Play a pivotal role in facilitating access to potentially life-saving treatments for patients worldwide as a Clinical Site Manager for Expanded Access Programs (EAPs). You will be the main point of contact for healthcare professionals (HCPs) in the US/US East Coast time zones, seeking access to treatment under expanded access for their patients, guiding HCPs through the entire EAP process, offering support at all steps.
Deliver an exceptional experience to clinicians providing care to Pomelo Care customers, measured by Clinician Net Promoter Score, quality metrics, and retention rates. Act as the primary internal point of contact for clinicians, design onboarding and training programs, and maintain the clinician handbook. Ensure clinicians meet client expectations, use data to identify improvements, and build relationships with clinician groups.
The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system. You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations and independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.