Remote Healthcare administration Jobs · Utilization Management

• Provide executive oversight of all clinical programs, including Behavioral Health and EAP services, establishing strategic direction and quality frameworks.
• Lead and supervise AVP-level clinical leaders, ensuring accountability and cross-functional alignment across clinical operations.
• Develop clinical strategies, policies, and procedures, oversee utilization management, and drive quality improvement initiatives.

Uprise Health transforms the delivery and accessibility of mental and behavioral healthcare, bringing whole person care to individuals worldwide. The company values compassion, integrity, collaboration, velocity, and advocacy, and seeks to foster a culture of care and support.

• Ensures that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
• Interacts directly with providers and their staff to obtain clinical information, and with members or their advocates to understand transition needs.
• Reviews information and makes recommendations to the collaborative team based on analysis of clinical material.

Mass General Brigham Health Plan is at the forefront of transformation with one of the world’s leading integrated healthcare systems. They provide members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

• Management and oversight of a quality team conducting quality assurance activities.
• Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements.
• Plans, organizes, and directs activities of Clinical Quality, including planning, training, and staff development.

HealthEdge is committed to workforce diversity and actively encourages all qualified persons to seek employment. They provide effective and efficient solutions to complex business problems.