Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to
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Clinical Laboratory Manager in United States
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Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements. Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives. The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals. The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives. Essential Role Responsibilities The Senior Quality Improvement Professional is responsible for improving clinical quality and performance outcomes among South Carolina network providers. Key responsibilities include: Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training and performanc
About the team OpenAI’s Forward Deployed Engineering team partners with healthcare organizations to deploy production AI systems across clinical, operational, and member-facing workflows. We work at the boundary of customer deployment and core platform development, using customer engagements to define repeatable architectures, evaluations, integrations, and operating standards for complex, regulated healthcare environments. About the role We are hiring a Forward Deployed Engineer (FDE) to own end-to-end deployments of our models within healthcare organizations, including payers, providers, health systems, and healthcare technology companies. You will lead technical discovery, architecture, implementation, evaluation, productionization, and handoff, translating complex customer workflows, data, infrastructure, and regulatory constraints into production AI systems. You will measure success through production adoption, measurable workflow impact, and evaluation loops that establish customer-specific benchmarks, acceptance criteria, and launch readiness. You’ll collaborate directly with customer technical and operational teams, alongside internal Business, Research, Product, Engineering, and Security partners, to deliver solutions and translate deployment learnings into product improvements. This role owns the technical solution; ownership of the commercial or executive relationship is not required. This role is based New York City. We use a hybrid work model of 3 days in the office per week. We offer relocation assistance. Travel up to 50% is required. In this role you will Own the technical solution end to end, from customer discovery and workflow scoping through architecture, hands-on implementation, evaluation, production deployment, adoption, and handoff. Partner credibly with customer engineers, operators, and domain experts to frame ambiguous problems, define scope, and translate payer, provider, or health-system workflows into technical requirements and measurab
About the Team OpenAI’s Forward Deployed Engineering team partners with healthcare organizations to deploy production AI systems across clinical, operational, and member-facing workflows. We work at the boundary of customer deployment and core platform development, using customer engagements to define repeatable architectures, evaluations, integrations, and operating standards for complex, regulated healthcare environments. About the Role We are hiring a Forward Deployed Engineer (FDE) to own end-to-end deployments of our models within healthcare organizations, including payers, providers, health systems, and healthcare technology companies. You will lead technical discovery, architecture, implementation, evaluation, productionization, and handoff, translating complex customer workflows, data, infrastructure, and regulatory constraints into production AI systems. You will measure success through production adoption, measurable workflow impact, and evaluation loops that establish customer-specific benchmarks, acceptance criteria, and launch readiness. You’ll collaborate directly with customer technical and operational teams, alongside internal Business, Research, Product, Engineering, and Security partners, to deliver solutions and translate deployment learnings into product improvements. This role owns the technical solution; ownership of the commercial or executive relationship is not required. This role is based in San Francisco. We use a hybrid work model of 3 days in the office per week. We offer relocation assistance. Travel up to 50% is required. In this role, you will: Own the technical solution end to end, from customer discovery and workflow scoping through architecture, hands-on implementation, evaluation, production deployment, adoption, and handoff. Partner credibly with customer engineers, operators, and domain experts to frame ambiguous problems, define scope, and translate payer, provider, or health-system workflows into technical requirements and mea
$60.2K – $100.4K/yr
ROLE SUMMARY The primary purpose of this job role is to function as a member of the Sample Logistics (SL) operations within Pfizer Vaccine Research and Development (VRD). The incumbent will be responsible for receiving samples from global clinical/study trials according to approved protocols and processes. The individual will participate in all aspects of tracking and documenting the chain of custody of samples. The incumbent’s role will include sample receipt, documentation, storage, tracking, aliquoting, distribution to the testing labs, and sample disposal. The colleague will work in a team setting and will share roles and responsibilities as assigned by the team leader/manager. ROLE RESPONSIBILITIES The incumbent will be required to complete all processes as detailed in Sample Management’s Standard Operating Procedures. The colleague will perform job responsibilities in compliance with GXP and all other regulatory agency requirements. The candidate will receive samples from clinical trial sites and enter samples into an electronic database management system. Performs sample storage and retrieval using manual freezers and BiOS (automated freezer storage system). Performs manual sample aliquoting and aliquoting using the Hamilton robotic instrument. Ship samples and lab supplies to external and internal testing labs. Assists in the general maintenance of the Hamilton robotic instruments. Participates in the shipment discrepancy resolution process. Completes documentation according to cGMP/GLP and all other regulatory agency requirements and archives documents as per applicable policies. Carries out sample disposal/sample destruction according to regulated policies and procedures Performs other duties as assigned. QUALIFICATIONS Must Have Bachelor of Science Degree or Bachel
We anticipate the application window for this opening will close on - 29 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life This is a field based position. We are seeking a committed professional to join our team, required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role, which also includes travel outside the territory, presenting opportunities for broader engagement. Across our global Neuroscience organization, we advance care for some of medicine’s most complex neurological and spinal conditions by combining innovative technology, data-driven insights, and deep clinical expertise. Within this organization, our Neurovascular operating unit is dedicated to advancing the treatment of stroke, brain aneurysms, and other vascular disorders through innovative endovascular technologies. By partnering with physicians and health systems, we help improve patient outcomes through solutions designed for revascularization, embolization, and precise intervention, supporting clinicians in delivering timely, effective care throughout the patient journey. Check us out on LinkedIn: Medtronic Neurovascular A Senior Terr
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: Manager, Care Program Strategy & Operations (Vaccine) Location: Remote/Virtual Role Description: The Manager, Care Program Strategy & Operations (Vaccine) plays a critical role within Oak Street Health’s Population Health organization, supporting the design, implementation, and scaling of programs that improve patient health outcomes and advance value-based care objectives. This role focuses on vaccine strategy and execution, driving initiatives that improve immunization rates, close care gaps, and support preventative care delivery across the organization. Serving as a key cross-functional leader, this individual partners closely with Population Health, Clinical Operations, Nursing, Providers, Patient Safety, Epic, and external healthcare partners to develop and implement innovative solutions that improve patient outcomes and operational performance. The role requires strong project management capabilities, stakeholder influence, and the ability to execute complex initiatives across multiple teams and partners. This is a highly visible role responsible for bringing new ideas from concept to execution, including the development of pilot programs, evaluation of results, and scaling of successful interventions across Oak Street Health centers nationwide. The Manager will also support strategic partnerships an
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
$133K – $212K/yr
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+
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
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