Clinical Risk Strategist (Hybrid) - Claims & Care
Sun Life Financial
Sun Life Financial is seeking a Senior Clinical Risk Consultant to apply medical knowledge and research to review claims, underwriting prospects, and renewals for appropriate, cost-effective care. This non-patient facing role supports a hybrid work model across the contiguous US states plus Alaska. You will coordinate with claims, underwriting, sales, and TPAs, identify cost savings opportunities, review complex treatment plans (transplants, CAR-T, gene therapies), and prepare educational #J-18808-Ljbffr Sun Life Financial
$117.5k - $222.99k
...healthcare financing, risk management and regulatory... ...healthcare cost and care management. MedInsight... ...seeking a Senior Product Strategist to shape product and platform... ...at translating complex clinical, operational, and... ...organizations, healthcare claims, clinical and pharmacy...RiskClaimsHourly payFull timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours$110.68k - $166.02k
...Hybrid Canton, MA Full time R9236 Who We... ...Harvard Pilgrim Health Care and Tufts Health Plan to... ...Management (UM) Supervisor, the Clinical Pharmacist is... ...GPI and USC) and NCPDP claims adjudication systems... ...system Participates in risk management activities,...RiskClaimsFull timeContract workWork from homeFlexible hours$117.5k - $222.99k
...solutions for healthcare cost and care management.MedInsight is a... ...healthcare financing, enterprise risk management and regulatory... ...MedInsight is seeking a Senior Product Strategist to lead product strategy and... ...operations, healthcare data, claims analytics, and health plan...RiskClaimsFull timeWork experience placementRemote workFlexible hours$93.7k - $177.68k
...for healthcare cost and care management. MedInsight... ...financing, enterprise risk management and regulatory... ...is seeking a Product Strategist to support the development... ...payer, provider, clinical, GMs, and technical product... ...initiatives with strong hybrid business and tech...RiskFull timeTemporary workWork experience placementRemote workFlexible hours$119k - $179k
...accelerate research and improve care for individuals and... ...and precise. Description The Clinical Operations Manager serves as a... ...critical study documentation, risk management strategy, site selection... ...business strategy for evidentiary claim development. Qualifications Minimum...RiskClaimsFull time- ...in Somerville, MA is seeking a Clinical Pharmacist to optimize health outcomes within our Care Management teams. You will perform... ..., evaluate therapies for high‑risk, chronically ill patients, and support... ...ACO contracts. This full‑time, hybrid role requires a PharmD,...RiskFull time
- ...Community Physicians, Inc. seeks a Clinical Pharmacist to optimize outcomes for high-risk patients. You will provide... ...ACO quality initiatives within a hybrid work model in Somerville, MA. The... ...role emphasizes collaboration with care teams, adherence improvement, and...Risk
$29 - $52 per hour
...remove friction and drive alignment between care providers and payers, and ultimately... ...organizations reduce costs while improving risk management, quality and revenue growth.... .... Connecting. Growing together. The Clinical Claim Review RN will be responsible for...RiskClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaRemote workMonday to FridayShift work$78.6k - $117.9k
...Description:**Sun Life embraces a hybrid work model that balances in-... ...:** In the **Senior Clinical Risk Consultant** role, you will use... ...professional experience to review claims, underwriting prospects and... ...recommend the best possible care, for an appropriate cost, in...RiskClaimsWork at officeLocal areaFlexible hours$83.5k - $95.4k
...volume, dynamic environment, the Clinical Authorization Specialist will... ...-benefit exclusion drugs, and claims. Located in Boston and the... ...in cancer research and patient care. We are united in our mission... ...health particularly among high-risk and underserved populations. We...RiskClaimsFull timeWork at office$160.6k - $240.8k
...DescriptionGeneral Summary:The Clinical Study Quality Lead (SQL),... ...and communicating compliance risks and overseeing action plans to... ...medical terminology, standards of care and disease states to assure the... ...so much more.Flex Designation:Hybrid-Eligible Or On-Site...RiskFull timeWork experience placementSummer workWork at officeRemote workFlexible hours2 days per week- ...Senior Clinical Authorization Specialist Reporting to the Prior Authorization... ..., appealing both pre and post claim denials, and completing... ...cancer research and patient care. We are united in our mission... ...particularly among high-risk and underserved populations. We...RiskClaimsWork at office
$20.5 - $27.59 per hour
...provide high-quality, high-value care to the patients and the... ...BILH is fully reimbursed for clinical services provided. The Patient... ...conditions that are a possible risk to others and adheres to appropriate... ...for services on initial claim submission. 17. Ascertains,...RiskClaimsHourly payContract workWork experience placementWork at officeRemote workShift work$97.5k - $141.5k
...Senior Risk Management SpecialistThe Senior Risk Management... ...level of quality care to the patients,... ...culture of safety.This hybrid position requires onsite... ...Actively collaborates with Claims Department to assist BMC... ...participates in clinical case review and case learning...RiskClaimsFixed term contractWork at officeLocal areaImmediate startFlexible hours3 days per week- Sun Life U.S. is seeking a Health & Risk Solutions Senior Claim Analyst to lead the evaluation, negotiation, and settlement of complex claims. The role requires advanced expertise in Medical Stop Loss and complex claims practices, with a focus on accurate payments and policyholder...RiskClaims
- Riverside Community Care is seeking a Clinical Director with independent LMHC or LICSW licensure to lead a multi-disciplinary team in delivering... ...community settings. Responsibilities include clinical supervision, risk mitigation, and guiding therapeutic interventions, with a...Risk
- Reportingto:Sr. Director,Clinical Data Management Do you have the passion... ...to become a new standard of care for patients with these... ...review of data trends and identify risks requiring mitigation.Ensure audit... ..., MA, and offers a flexible hybrid work model with a minimum of 2...Risk2 days per week
- ...powering the acceleration of clinical research to transform patient... ...directly in the communities where care is delivered across... ...also help identify regulatory risks, resolve complex issues, and improve... ...professionally and personally.Hybrid work environment with in-office...RiskTemporary workWork at office2 days per week
$177k - $278.08k
...new scientific, safety and clinical data, as well as Health... ...provided to patients and Health Care Providers while minimizing the risk of write-offs.Responsible... ...strategy, product claims and information in the CCDS... ...accordance with Takeda's Hybrid and Remote Work policy....RiskClaimsMinimum wageLocal areaRemote workWorldwide$120k - $135k
...company redefining the cancer care experience for patients,... ...based health interventions and a hybrid in-person + virtual care model... ...billing vendor management, claims operations, and risk adjustment, while partnering closely with Clinical Operations, Finance, Product,...RiskClaimsContract workLocal areaRemote work- ...for-profit, we support patient care, research, teaching, and... ...General Brigham.Job SummaryThe Clinical Pharmacist optimizes health outcomes... ...of patient care for a high-risk patient population within our... ...hours and adapt to a dynamic, hybrid workflowAdditional Job Details...RiskFull timeContract workWork at officeLocal areaRemote workWork from homeMonday to FridayFlexible hours
$225k - $260k
...redefining the cancer care experience for patients... ...health interventions and a hybrid in-person + virtual... ...Delivered a company-wide legal risk assessment and a... ...Kickback Statute, and False Claims Act exposure across... .... Partner with Clinical Operations and the COO'...RiskClaimsContract workFor contractorsLocal area$150k - $200k
...powering the acceleration of clinical research to transform... ...the communities where care is delivered across... ...strategy, policies, controls, risk management, monitoring,... ...and personally. ~ Hybrid work environment with... ...BARRED FROM FILING A CLAIM UNDER the provisions of...RiskClaimsTemporary workWork at officeLocal areaRemote work2 days per week$134.8k - $146.1k
...stakeholders and external partners to assess risk exposures, manage claims, and support compliance with... ...breakthroughs in cancer research and patient care. We are united in our mission of... ...solutions. Collaborate with clinical, legal, and operational teams to evaluate...RiskClaims$73 - $90 per hour
...Join to apply for the Licensed Clinical Social Worker role at Grow Therapy Base pay... ...handle credentialing, billing, and insurance claims so providers can enjoy the freedom of... ...should be able to serve the communities they care most about — not just the small number of...ClaimsContract workPrivate practiceRemote work$115.2k - $158.4k
...Become a part of our caring community The Clinical Performance Strategy & Measurement... .... Identify operational risks and develop mitigation strategies... ...Knowledge of healthcare claims data, clinical coding... ...Information To ensure Home or Hybrid Home/Office employees’...RiskClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$135.23k - $150.25k
...with performance targets while minimizing risk and exposure. Responsible for monthly... ...requests to determine the merit of out-of-scope claims and reasonableness of the compensation.... ...to travel between MA/CT/NH as necessary.HYBRID SCHEDULE: Eversource supports work-life...RiskClaimsFull timeContract workFor contractorsH1bWork at officeRemote work$119k - $150k
...Everest is a global leader in risk management, rooted in a rich,... ...creation for all stakeholders, who care deeply about our impact on... ...locations. The position is primarily hybrid; however, remote consideration... ....Collaborate closely with Claims, Actuarial, Operations,...RiskClaimsFull timeFor contractorsWork at officeRemote workFlexible hours- ...scheduling, credentialing, and claims processing. High... ...Telehealth: Deliver virtual care safely from any private remote... ...psychiatric diagnostic evaluations, risk assessments, and mental status... ...Maintain complete, timely clinical progress notes within the EHR...RiskClaimsHourly payFull timePart timeRemote workFlexible hours
- Location: Boston (Hybrid)Organization Summary:Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable... ..., support, and maximize the use of clinical, financial, and administrative... ...Electronic Health Records, medical claims, and other health care dataFlexible...ClaimsFlexible hours
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