Clinical in United States

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1+ year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi

Become a part of our caring community As a Care Management Support Assistant, you will help members take the next step toward better health and well-being. You will do this by connecting with them over the phone, completing important non-clinical assessments, identifying barriers to care, and helping them access resources and benefits. We are looking for people who show compassion and document customer issues in detail, can work in a call center environment, and motivate themselves through work that directly supports members and care teams. This is a remote position, and the assigned shift will be 11:30 AM–8:00 PM Eastern Standard Time. Job Description What You Will Do Engage members by phone to encourage participation in care management programs. Complete required assessments and questionnaires to help identify health risks, care needs, and opportunities for clinical team follow-up. Assist members who need support scheduling doctor’s appointments or connecting with appropriate care resources. Identify and help address barriers to preventive screenings, benefits, and health-related services so members can close gaps in care. Support members in understanding, retaining, and accessing benefits that contribute to their overall health and well-being. Manage both inbound and outbound calls in an auto-dialer environment while documenting member information. What Success Looks Like You create a positive member experience by treating each interaction with respect, patience, and professionalism You demonstrate compassion, integrity, and sound judgment when supporting members with sensitive health-related needs You listen to

Become a part of our caring community The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care r

Become a part of our caring community As a Medical Assistant, you will be a part of the Clinical Care Team engaging with our patients to develop lifelong well-being and health. The Medical Assistant role makes a difference in the patient care we offer and assists physicians and other clinicians by providing a unique blend of skills to perform prescribed medical treatment. Medical Assistants are multiskilled health professionals responsible for performing administrative and clinical tasks in our primary care facilities while delivering outstanding customer service and maintaining positive patient engagement. Location : CenterWell Senior Primary Care Poinciana office address: 1050 Cypress Parkway; Kissimmee, FL 34759 Medical Assistant Job Tasks: Perform pre-visit planning based on patient visit type Manage the provider's schedule to ensure efficient workflow Obtain and record medical history and vital signs Room patients and assist healthcare providers with medical procedures and treatments Perform specimen collection and point of care testing Prepare and administer medications under the direction of healthcare providers Ensure accurate documentation in the electronic health record (EHR) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures Maintain established quality control standards Use your skills to make an impact Additional Information Required Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5+ years of experience and approval from Provider High school diploma or equivalent CPR Certified Bilingual proficiency in English and Spanish - must pass proficiency exam befo

Become a part of our caring community As a Medical Assistant you will be the first contact for patient care, responsible for administrative responsibilities in addition to patient care. Working onsite in a clinical environment and reporting to the Center Administrator you will perform varied activities and moderately complex administrative, operational, and customer support assignments. Location Address CenterWell Senior Primary Care office located at: 4886 N Dowlen Rd., Beaumont, TX., 77708 You will be reporting to the: Supervisor, Center Administration Job Responsibilities As a Medical Assistant you will perform clinical tasks such as: You will perform pre-visit planning based on patient visit type You will obtain and record medical history and vital signs You will room patients and assist healthcare providers with medical procedures and treatments You will perform specimen collection and point of care testing You will prepare and administer medication under the direction of healthcare provider You will ensure accurate documentation in the electronic health record (HER) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures Required Qualifications An active Certified Medical Assistant/CMA or Registered Medical Assistant/RMA certification from one of the following organizations: AAH, AAMA, AMT, ARMA, MedCa, NAHP, NAHT, NCCT, or NHA Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5+ years of experience and approval from Provider High school diploma or equivalent 1+ years of MA experience Phlebotomy experience Medication/vaccine administration ex

Job Title Medical Safety Manager - Ultrasound Job Description Medical Safety Manager, Ultrasound The Medical Safety Manager independently oversees safety surveillance activities for medical products by analyzing data from post-marketing surveillance, literature reviews, and real-world evidence to identify risks and ensure patient well-being. The role supports regulatory compliance through the preparation of safety-related documentation, including Risk-Benefit Analyses, protocols, Clinical Study Reports, and Clinical Evaluation Reports. Your role: Independently conducts comprehensive safety evaluations using data from post-marketing surveillance, literature reviews, and clinical trials to proactively identify and assess potential risks and safety signals. Provides critical safety insights and recommendations for risk management activities, including Health Hazard Evaluations, Risk-Benefit Analyses, and recall procedures, ensuring robust patient safety measures are in place. Supports New Product Introduction, clinical studies, and post-marketing efforts by delivering safety-related perspectives and collaborating on safety inputs for regulatory submissions and key documentation such as RBAs, protocols, Clinical Study Reports, and Clinical Evaluation Reports. Responds to safety-related inquiries from healthcare professionals, patients, and internal stakeholders, fostering trust through transparent communication and supporting the implementation of safety policies, procedures, and programs to promote a culture of compliance. Stays current with evolving medical product safety regulations and guidelines, offering input into the design and execution of safety studies and vigilance activities to ensure adherence to requirements throughout the product lifecycle. You're the right fit if: You’ve acquired 5&#43

Work Flexibility: Field-based GENERAL DESCRIPTION: Utilizes a wide array of knowledge, technical skills and critical thinking abilities to facilitate job functions during surgical procedures as well as preoperative and postoperative equipment management. ESSENTIAL FUNCTIONS: · Provides clinical surgical support by managing all relevant equipment. · Anticipates related device needs of the O.R. staff and surgeon during surgical procedures. · Is responsible for trouble-shooting and maintaining Stryker equipment and or other related devices. · Works with surgeons, O.R. personnel, central processing, biomedical and all other related personnel. · Maintains knowledge base of equipment and disposable products through Stryker education training programs. · Provide physicians and OR personnel with information on new and current products. · Must be able to accurately and honestly record and report data metrics related to all specific job functions on a monthly basis. · Responsible for maintaining up-to-date account information to ensure continuous high levels of service at the account; including all vendor credentialing required by the account. · Accurately records and reports all surgical procedure information. · Adheres to all Stryker and medical facility policies, standards and procedures. · Analyze and resolve both routine and non-routine product issues expediently using independent judgment. · Maintain professional appearance, work ethic, and attitude required by Stryker and the medical facility. · Adhere to (HIPAA) and other related patient confidentiality policies and procedures. · Provide support/coverage on all shifts at your assigned account, as well as provide support/coverage at other account in and outside your region; other shifts might i

Job Title Contract Strategy- Corporate Accounts (Colorado Springs or Nashville TN) Job Description Contracts Specialist – Corporate Accounts (Colorado Springs, CO or Nashville, TN) The Contracts Specialist – Corporate Accounts leads the negotiation and management of complex sales contracts, partnering with cross-functional teams to mitigate risk, optimize contract performance, and ensure alignment with business, financial, and legal objectives. This role serves as a trusted advisor to senior leadership, driving best practices and strategic decision-making throughout the contract lifecycle. Your role: Lead end‑to‑end contract management for highly complex sales agreements, ensuring all obligations are met and fully aligned with organizational, financial, and legal requirements. Provides expert advice and strategic insights to senior management and other internal stakeholders on contractual matters, risk assessments, and mitigation strategies, ensuring alignment with organizational objectives and legal requirements. Enhance and optimize contract management processes, implementing best practices, improving systems, and strengthening operational efficiency and risk controls. You're the right fit if: Minimum 2 years of experience with a Bachelor’s Degree in areas such as Healthcare Consulting, Clinical Education and Training, MRI Clinical Practice, Pediatric MRI, or equivalent; Experience working in pediatric MRI departments, children’s hospitals, or academic medical centers. Familiarity with pediatric sedation workflows, anesthesia coordination, and family-centered care models. Bachelors Degree in addition to 5+ years of experience in contract strategy, national accounts, pricing, or commercial operations within healthcare, med‑tech, pharma, or a similarly complex

Become a part of our caring community The Lead Software Engineer codes software applications based on business requirements. The Lead Software Engineer works on problems of diverse scope and complexity ranging from moderate to substantial. The Lead Software Engineer standardizes the quality assurance procedure for software. Oversees testing and debugging and develops fixes. Researches complaints and makes necessary adjustments and/or recommendations to resolve complex software related issues. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Key Responsibilities Technical Architecture and Ownership:** Design and own the end-to-end architecture of Centerwell's AI systems, including LLM-powered clinical tools, RAG pipelines, harnesses, agent-based workflows, and intelligent automation. Make and communicate foundational technical decisions in close collaboration with the broader engineering team. Model Development and Fine-Tuning:** Evaluate, select, and where appropriate guide the fine-tuning of foundation models. Establish model evaluation frameworks that prioritize safety, accuracy, and clinical relevance. Clinical and Product Partnership:** Collaborate closely with product managers, designers, clinicians, and data stakeholders to understand care delivery workflows and translate them into well-scoped, high-impact AI features. HIPAA Compliance and Responsible AI:** Ensure all AI systems are designed, deployed, and monitored in compliance with HIPAA and Humana's Responsible AI standards, including participation i

Job Title Medical Safety Manager, Hospital Patient Monitoring Job Description Medical Safety Manager, HPM The Medical Safety Manager, Hospital Patient Monitoring is responsible for conducting comprehensive evaluations of safety information sourced form a variety of channels such as Post-Marketing Surveillance (PMS) and literature searches, working under limited supervision. Your role: Provides essential support in bolstering patient safety by actively contributing insights and recommendations to critical processes such as Risk Management, Health Hazard Evaluations (HHE), Risk-Benefit analyses, and recall procedures. Offers valuable assistance in delivering safety-related perspectives for New Product Introduction (NPI) projects, clinical studies, and Post-Marketing Surveillance (PMS) efforts, facilitating informed decision-making. Collaborates effectively to furnish pertinent safety inputs for regulatory submissions and key documents such as Risk-Benefit Analyses (RBA), protocols, Clinical Study Reports (CSR), and Clinical Evaluation Reports (CERs), ensuring compliance and transparency in safety evaluations. Conducts literature reviews and surveillance activities to identify emerging safety issues, ensuring proactive identification and mitigation of potential risks. Provides answers to safety-related inquiries from healthcare professionals, patients, and internal stakeholders, fostering trust and transparency in communication regarding product safety. Contributes to the implementation of safety-related policies, procedures, and programs to promote a culture of safety and compliance within the organization. Maintains awareness of evolving regulations and guidelines related to medical product safety and ensures compliance with applicable requirements. Provides input into the design and conduct of safety studies and medical device vigil

Become a part of our caring community Most AI engineering jobs are a thin wrapper around a model API. This role is different. We build the platform that transforms millions of clinical documents into trusted, actionable data. Our systems use large language models (LLMs) to read medical records, extract structured facts, answer complex questions with citations back to the source document, and route ambiguous cases to human experts for review. Our users make decisions that impact real healthcare outcomes, so “good enough” is not good enough. Building AI systems that are accurate, reliable, auditable, and scalable is at the core of this role. As a Senior AI Applied Engineer, you will design, build, deploy, and operate production AI systems used at scale within one of the largest health insurers in the United States. You will own solutions end-to-end, from user experience and APIs to model orchestration, evaluation frameworks, infrastructure, and production operations. Why Join Us Build production AI systems where LLMs are in the critical path, not just demos or proofs of concept. Work on extraction, retrieval, agentic workflows, and human-review systems that process real healthcare data at scale. Own projects end-to-end across frontend, backend, AI orchestration, infrastructure, deployment, and operations. Solve challenging problems around accuracy, explainability, traceability, and reliability in regulated environments. Ship quickly in a small, high-impact team that embraces AI-assisted development and rigorous quality standards. Build systems that continuously improve through expert feedback, evaluations, and human-in-the-loop workflows. Key Responsibilities Design, develop, and deploy full-stack AI-powered application

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Location Bureau County or surrounding area. Program Overview Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Fundamental Components & Physical Requirements Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. Uses clinical to

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Company: Oak Street Health Title: Medical Scribe (Clinical Informatics Specialist) Location: 1113 Carlisle Rd, York, PA 17404 Role Description: At Oak Street Health, Clinical Informatics Specialists (CIS), or Medical Scribes, serve as vital clinical documentation assistants, supporting our primary care providers. Each Scribe is paired with a single provider, joining them in the exam room, during team huddles, and conducting post-visit summaries to ensure accurate, specific, and timely documentation. Our Scribes receive extensive training to become experts in our value-based care model, ICD-10 and CPT coding, electronic medical records, and population health. Their contributions allow our interdisciplinary team to proactively identify and help close care gaps, provide preventative measures for chronic conditions, and provide great patient experiences. This role is designed for individuals seeking significant clinical exposure, particularly those on a pre-med or healthcare administration track. Because providers and patients rely heavily on this partnership, successful candidates should expect a 1 - 2 year commitment. This opportunity offers an immersive, paid position to gain clinical experience, chronic disease management, and a deep understanding of patient care workflows before advancing to MD, PA, Nursing, or other professional hea

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is for an every other weekend home clinic position at the Madison clinic location. A Brief Overview As the largest retail health care provider in the nation and a Fortune Top 10 industry leader, MinuteClinic offers a unique opportunity to deliver affordable, accessible, and comprehensive high‑quality care to patients, families, and communities. Our providers are empowered to practice holistically with strong clinical support, collaborative resources, and a unified “one store, one team” approach. This is a clinic-based role focused on delivering the highest-level quality in-person patient care. Virtual care visits may be conducted from the clinic during periods of lower onsite patient volume and when doing so does not delay or interfere with in‑person care. MinuteClinic is proud to hold the American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation, recognizing our commitment to a healthy work environment through Transformational Leadership, Quality, Safety, Shared Governance, Well-being, and Professional Development. What Our Providers Enjoy Autonomy to manage your practice with dedicated collaborative and organizational support Flexible scheduling and strong work–life balance Exceptional tools, training, and clinical resources Evidence‑based guidelines and access to leading assessment and treatme