Remote Clinical Review Manager: Healthcare Integrity Lead
Centene Corp.
- Remote job
Centene Corp. in the United States is seeking a Manager of Clinical Review for a 100% remote leadership role. You will lead a team of clinical investigators, oversee complex Fraud, Waste & Abuse cases, and collaborate with providers and stakeholders across multiple markets. The role requires a strong clinical foundation and experience in healthcare investigations. Responsibilities include auditing reviews, identifying risk patterns, and driving cost-effective improvements while ensuring #J-18808-Ljbffr Centene Corp.
- Centene is seeking a Manager, Clinical Review for a remote leadership role within Healthcare Integrity. You will lead a team of clinical investigators, oversee complex Fraud, Waste & Abuse cases, and apply your clinical expertise across multiple markets to identify trends...Remote job
- ...Lead Clinical Data Manager More than one million people in the... ...specifications, data review plans and data transfer... ...by law. For remote-based positions, this... ...passion, courage, and integrity. Excellence in our work... ...patients and their healthcare providers. Orca Bio...Remote workFull timeLocal area
- Centene Corporation is hiring a Manager of Clinical Review for a remote leadership role in healthcare integrity. You will lead clinical investigators, oversee complex FWA cases, and collaborate with providers across markets to ensure proper utilization of services. The...Remote job
- Commence is seeking a Medical Review Manager to lead the Program Integrity medical reviews nationwide. You will supervise a clinical review team of RNs, LPNs, coders and support staff... ...’s or bachelor’s in nursing. This fully remote/office role collaborates with CMS and law...Remote workWork at office
- A leading global healthcare company is seeking an experienced Clinical Data Manager/Clinical Data Reviewer for a full-time, remote role. You will support clinical data management processes, ensure data integrity, and collaborate with clients on complex studies. The ideal...Remote jobFull time
$223.8k - $313.1k
...inpatient care through clinical expertise and... ...necessity review. This position... ...reasoned utilization management determinations.... ...emphasizes integrity,... ...directly to a Lead Medical Director... ...While this is a remote position, occasional... ...wellness and smart healthcare decisions for you...Remote workBi-weekly payFull timeTemporary workWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$35 - $37 per hour
...Lead RN Reviewer Cohere's Service Operations team... ...that our healthcare partners are supported... ...and report to the Clinical Supervisor of Service... ...in healthcare, managed care, or... ...style suited for a remote, fast-paced environment... ...launching our Payment Integrity Suite, anchored...Remote workHourly payFlexible hours- ...seeking a senior leader to manage advanced, complex medical claim reviews. You will provide... ...compliance, and drive payment integrity goals while mentoring a... ..., CPT/HCPCS coding, and clinical guidelines to shape... ...methodologies across a remote team with travel up to 2...Remote job
- ...Role The Senior Manager of Medical and Clinical Claim Policy and... .... *This is a remote role. Primary... ...Review, update, evaluate... ...work closely with Healthcare Economics, Medical... ...Solution (CES) and lead initiatives involving... ...determinations, and benefit integration. Leads the...Remote workLocal areaFlexible hours
$87.7k - $157.8k
...28 million members as a clinical professional on our Medical Management/Health Services team. Centene... ...: Manager, Clinical Review Remote Clinical Leadership Opportunity | Healthcare Integrity | Fraud, Waste & Abuse... ...leadership role where you’ll lead a team of clinical...Remote workFull timePart timeWork at officeFlexible hours- ...direction of the Regional Manager, Clinical Documentation Integrity (CDI), this position... ...team who work onsite and remotely. Communicates effectively... ...all other members of the healthcare team regarding clinical documentation... ...as part of the review process and remain current...Remote jobFull timeWork at officeLocal areaShift work
- UW Medicine is seeking a Revenue Integrity Manager to lead the RI Analyst team and ensure complete charge... ...expertise and collaboration with clinical leadership to resolve issues... .... Ideal candidates have 6-8 years in healthcare finance/revenue integrity, strong analytics...Remote job
$88 per hour
...capture, charge integrity, and revenue... ...billing practices in healthcare. Key... ...submission. Review AI-generated charge... ...compliance. Audit clinical departments for... ...errors. Manage the charge description... ...Work Terms ~ Remote, hourly... ...collaborate with a leading AI research...Remote workHourly pay- Job-ID32430297Reference26-00957Remote50% Remote Responsibilities: Lead and manage clinical data management activities for oncology clinical trials, ensuring... ...optimal configuration and functionality. Conduct thorough reviews of clinical data, identifying trends, inconsistencies...Remote workWork at office
- Mercor is seeking a Medical Revenue Manager to oversee charge capture and revenue integrity functions within a remote setting. The role requires at least 5 years of experience in related fields, such as healthcare compliance and charge integrity. The successful candidate...Remote job
- Avalon Healthcare Solutions seeks a Client Integration Lead to guide clients through Lab Benefit Management implementations. You’ll act as the primary liaison from kickoff through go-live, coordinating with internal teams to translate requirements into actionable delivery...Remote job
- A healthcare solutions company is seeking a Senior Tech Lead in Atlanta, GA, to serve as the technical authority for all Workday integrations. The role requires in-depth expertise in Workday integrations, API engineering, and strong leadership skills to mentor other engineers...Remote job
- A leading healthcare solutions firm seeks a Payment Integrity Supervisor to oversee daily operations of the payment integrity... ...team. Responsibilities include managing quality assurance measures and resolving... ...service delivery. This remote position requires strong experience...Remote jobDaily paid
$228.1k - $325.85k
...are pioneering new healthcare solutions for... ...act with unwavering integrity and are deeply committed... ...iADCs). The Asset Lead has overall and... ...life cycle management who reports to the... ...nomination through clinical development, global... ...in Northbrook, IL. Remote work from anywhere...Remote workWork at officeLocal areaWork from homeWorldwide- ...Senior Director, Portfolio Integration Lead Cancer is unrelenting, but... ...strong partnerships across the healthcare ecosystem. We focus our... ...is a senior role in Oncology Clinical Development, responsible for... ..., with a mix of on-site and remote work. Remote or fully home-working...Remote workLocal areaWork from home
- ...Center for Life Management (CLM) provides the... ...and elders. Our Integrated Care Program is a... ...approach to whole healthcare that encompasses... ...conditions. The Clinical Supervisor oversees... ...performance reviews. Work in conjunction... ..., and/or remote via telehealth to...Remote workFull timeTemporary workWork at officeRelocation packageFlexible hours
$120k - $150k
...impact. The Senior Clinical Study Manager is responsible... ...will independently lead end-to-end study... ...Programs and will be a remote role.In this role... ...regular reviews of clinical study... ...trends, ensure data integrity, and proactively... ...in Life Sciences, Healthcare, or a related field...Remote workFull timeWork experience placement- ...seeking an EDI Solutions Analyst to own end-to-end EDI 278 integrations in a remote-capable role across the U.S. You will monitor and... ...Azure/Postgres/Snowflake environments. This role requires healthcare IT experience and strong SQL skills. You’ll collaborate with...Remote job
$79.72k - $128.12k
...performing quality reviews of medical... ...Indicators, HAC, Clinical Documentation Improvement... ...documentation, integrity and accurate code... ...from DRGV management.Communicates, cooperates... ...to transform healthcare. We encourage all... ...of nursing, and a leading school of medicine...Remote workFull timeTraineeshipWork experience placementLocal area$74.29k - $96.14k
...Registered Dietitian for a Clinical Nutrition Manager role at Altru Health... ...sign on bonus, 1-2 remote days per week.... ...performance evaluation, pay reviews and hire/fire... ...-depth knowledge of healthcare regulations and... ...management, and other integrated solutions worldwide....Remote workLocal areaWorldwideRelocation package2 days per week1 day per week- ...on patient care, clinical excellence, and employee... ...Summary The Team Manager (TM) provides... ..., the TM owns the integrity of the Electronic... ...This position is non-remote and non-... ...thorough eligibility reviews, and effective interdisciplinary... ...experience in a healthcare setting. Strong...Remote workContract workLocal areaRelocation
- ...Solutions is seeking a Payment Integrity Nurse I to perform post-service claims reviews, ensuring accurate... ...within a flexible remote model across certain western... ...position emphasizes clinical judgment, coding knowledge... ...and improve healthcare outcomes. #J-18808-Ljbffr...Remote jobFlexible hours
- ...Description Description: As a Lead Healthcare Integration Specialist , you will... ...Overview This is a 100% remote position within the... ...migrating complex customer clinical datasets onto our systems... ...You will skip high-level management fluff to write code, configure...Remote work
$245k - $260k
...Medical Director Clinical Leader Location... ..., Dallas, TX Remote PRIMARY PURPOSE... ...and quality management of the health plan... ..., healthcare administration,... ...preferred. Peer Review, medical policy... ...the ability to lead major organizational... ...activities. Quality Integrate health literacy...Remote workPermanent employmentFull timeContract workPart timeLocumPrivate practiceWork at officeVisa sponsorshipRelocation packageMonday to FridayFlexible hours- ...seeks an RN with coding credentials to lead Payment Integrity initiatives focused on preventing... ...regulatory requirements, and drive DRG-related review programs across MS-DRG and APR-DRG... ...requires leadership of auditors and clinical professionals, collaboration with multiple...Remote job
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