Remote Clinical Operations Manager — Medicare & CMS Compliance
WPS—A health solutions company
- Remote job
A healthcare solutions provider is seeking a Clinical Manager to plan and evaluate clinical operations for Medical Review. This remote or hybrid position involves ensuring compliance with CMS regulations, developing strategic reports, and mentoring the Clinical Med Management team. The ideal candidate must have a nursing degree, an active RN license, and at least five years of clinical experience, with three years in leadership roles. Competitive benefits and a performance bonus are offered. #J-18808-Ljbffr WPS—A health solutions company
- ...healthcare solutions organization is seeking a Clinical Manager responsible for overseeing clinical operations and ensuring compliance with CMS regulations. The ideal candidate will... .... This role offers the opportunity for remote or hybrid work arrangements across various...Remote jobCms
- ...healthcare solutions provider is seeking a Clinical Manager in Georgia to oversee clinical operations and ensure compliance with CMS regulations. The role involves developing and... ...of CMS guidelines. The position offers remote and hybrid work options and various benefits...Remote jobCms
$100k - $120k
...solutions provider is seeking a Clinical Manager to oversee clinical operations for Medical Review. This role includes... ...strategies to ensure compliance with CMS guidelines while mentoring a team... ...experience. This position offers remote and hybrid work options and a competitive...Remote jobCms- A healthcare solutions provider is seeking a Clinical Manager in Colorado. This remote or hybrid role requires overseeing clinical operations, developing CMS reports, and ensuring regulatory compliance. Candidates must hold an active RN license, have 5+ years of clinical...Remote workCms
- Clinical Operations Manager, Pulmonary Rehabilitation New York City, New York What... ...of program quality, compliance, and growth. Key responsibilities... ...rehab services meet CMS, Medicare, and industry regulatory requirements... ...platforms, EHRs, and remote care models is a plus. NYC...Remote workCmsFor contractorsWork at office3 days per week
- Job Requirements Clinical and Regulatory Manager (RN) - DialysisOperations... ...Type & Travel: Remote with 60-75% travel... ...quality, regulatory compliance, and outcome improvement... ...corporate clinical and operational leaders to drive... ...full compliance with CMS Conditions for Coverage...Remote workCmsLocal area
- ...( is a not-for-profit Medicare Advantage insurance plan... ...: Provider Data Management role manages the integrity... ...data to maintain compliance with Federal and local... ...and Medicaid Services (CMS) requirements. Additionally... ...alongside all other Operations Resolution Specialists...Remote workCmsFull timeTemporary workWork at officeLocal areaShift work
- ...medical decision-making and ensure compliance with Medicare policies. The role requires an... ...include providing clinical expertise, collaborating with CMS, and supporting program integrity... ...initiatives. This position includes remote work opportunities in various states...Remote workCms
$223.8k - $313.1k
...Medical Director to oversee clinical services and ensure compliance with CMS guidelines. This remote position requires an MD or DO... ...reviewing clinical cases for Medicare and Medicaid members, ensuring... ...and contributing to medical management improvements. The role offers...Remote workCms- ...Medical Director to oversee the compliance of healthcare services for Medicare and Medicaid. The role necessitates reviewing clinical cases, ensuring alignment with CMS guidelines, and working... ...experience. This position allows for remote work and includes opportunities...Remote workCms
$223.8k - $313.1k
...evaluate healthcare services and ensure compliance with CMS regulations. The role entails reviewing clinical cases to determine medical necessity for Medicare and Medicaid members. Candidates... ...clinical experience. The position is remote with the need for occasional travel...Remote workCms$223.8k - $313.1k
...services company is seeking a Medical Director to oversee clinical case evaluations and ensure compliance with CMS guidelines. Applicants must hold an MD or DO degree... ...of direct clinical patient care experience. This remote position requires strong communication skills and...Remote workCms$223.8k - $313.1k
...Director in Austin, Texas. You will ensure healthcare services align with CMS guidelines and evaluate medical necessity for Medicare and Medicaid members. This remote role requires strong clinical and communication skills, along with significant experience in patient...Remote workCms- ...this mission into clinical care. The ACCESS program... ...care team to manage cardiometabolic... ...You will own the operational engine of ACCESS —... ...program — scheduling, compliance, billing, and... ...Experience with CMS chronic disease management... ...role is fully remote. We have a preference...Remote workCmsHourly payPermanent employmentFull timeContract workPart timeFor contractorsWork at office
- ...ensure healthcare services align with CMS guidelines. The role requires reviewing clinical cases for Medicare and Medicaid members, ensuring compliance, and participating in call rotations.... ...patient care. This position is remote with a focus on regulatory compliance...Remote workCms
- ...is seeking a Neurologist Medical Director to ensure compliance with clinical guidelines for Medicare beneficiaries. The role involves conducting case reviews... ...active medical license. This position is primarily remote, offering a full-time work schedule with comprehensive...Remote workCmsFull time
- .... Responsibilities include reviewing clinical cases for Medicare and Medicaid, ensuring compliance with CMS policies, and contributing to operational improvements. Required qualifications... ...clinical experience. This role allows for remote work, helping maintain work-life...Remote workCms
- ...seeking a Medical Director to oversee compliance with CMS Medicare Guidance and review healthcare... ...compliance, and identifying operational improvements. Candidates must have... ..., and at least 10 years of clinical experience. This remote role requires strong communication...Remote workCmsWork at office
$223.8k - $313.1k
...looking for a Medical Director to review clinical eligibility for Medicare and Medicaid services. This role involves ensuring compliance with CMS and organizational standards while... ...of clinical experience. The position is remote with required calls and occasional travel...Remote workCms- ...seeking a Medical Director responsible for reviewing clinical cases and ensuring compliance with CMS guidelines. This remote position requires an MD or DO degree, board... ...dedicated to improving health outcomes for Medicare and Medicaid members while working in a supportive...Remote workCms
- ...seeking a Medical Director to ensure compliance with CMS Medicare guidance and evaluate healthcare services... ...members. The role involves reviewing clinical cases, applying clinical guidelines,... ...experience. This position offers remote work and comprehensive benefits including...Remote workCms
$223.8k - $313.1k
...services, ensuring alignment with CMS guidelines for Medicare and Medicaid. Responsibilities include reviewing clinical cases for medical necessity and compliance, supporting organizational... ...and analytical skills. This is a remote position requiring occasional office...Remote workCmsWork at office$60.3k - $133.4k
...the enterprise credentialing operation to include managing and monitoring processes... ...source verification. Ensure compliance with the appropriate accrediting... ...Knowledge of NCQA, URAC, CMS, and state Departments of... ...: 3 days in office; 2 days remote. Sponsorship is not...Remote workCmsFull timeWork at officeFlexible hours$223.8k - $313.1k
...organization in Alabama seeks a Medical Director to evaluate healthcare services and ensure compliance with CMS and Humana policies. This remote role involves reviewing clinical cases for Medicare and Medicaid members and making decisions that adhere to regulatory standards....Remote workCms- ...Position Summary The Coding Operations Manager provides oversight of end-to... ...workflows to ensure accuracy, compliance, and alignment with urgent... ...care-specific guidelines Lead clinical documentation improvement (... ...preferred This is a remote position. #J-18808-Ljbffr...Remote workCms
- ...Description Job Description Director, Clinical Operations Remote Company Overview: AMSURG is... ...order to promote patient safety, compliance with applicable CMS and State regulations and... ...Clinical Quality plans within center Manages review and approval of corporate...Remote workCmsWork at officeLocal areaFlexible hoursAfternoon shift
$223.8k - $313.1k
...on fundamentals of CMS Medicare Guidance on following... ...requirements, Humana policies, clinical standards, and... ...of regulatory compliance. This secures compliance... ...for medical management operational improvements Participate... ...Information Workstyle: remote work at home Hours:...Remote workCmsFull timeTemporary workApprenticeshipWork at officeWork from homeMonday to Friday- ...Head of IT to build and lead IT Operations as a strategic function. This role requires transforming compliance into a competitive advantage... .... Responsibilities include managing a global IT team and nurturing... ...work arrangements are included. #J-18808-Ljbffr Sanity CMSRemote jobCmsFlexible hours
- ...Clinical Operations Manager – Medical Device Startup Location: United States (Remote) Industry: Medical Devices / Structural Heart / Cardiovascular Job Type: Part-Time About... ...day clinical trial activities and ensuring compliance with GCP, FDA, and institutional guidelines...Remote workHourly payPart time
- ...Description The Pharmacy Manager, Benefit Operations (Emory Health Plan)... ...PA criteria, clinical edits, copay rules, accumulators... ...for governance and compliance. Validates... ...compliance with CMS, DOL, ERISA, and internal... ...University location. Remote work from home day...Remote workCmsWork from home
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