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 At CVS/Aetna, we're pioneering a total approach to health and wellness. As a Decision Scientist on the Analytics & Behavior Change team, you'll build industry-leading analytics, data, and technology platforms to help reimagine health care. This position will play a critical role within a cross-functional team, delivering powerful solutions. Utilization Management (UM) ensures consistent delivery of the right care, in the right setting, by the right people. The UM Data Science team leverage data, analytics and AI solutions to transform UM operations and optimize provider and member experience. Develop analytic solutions to optimize Utilization Management in healthcare Explores, examines and interprets large volumes of data in various forms Performs analyses of structured and unstructured data to solve moderately complex business problems Utilizing advanced statistical techniques and mathematical analyses Develops data structures and pipelines to organize, collect and standardize data that helps generate insights and addresses reporting needs Uses data visualization techniques to effectively communicate analytical results and support business decisions Creates and evaluates the data needs of assigned projects and assures the integrity of the data </u
Jobs in United States
Provider Network Relationship Manager in United States
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Explore current provider network relationship manager jobs across United States. Filter by work mode, employment type, experience, department, date posted and distance.
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. Title: Medical Scribe Monday - Friday, 8a-5p, full time Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. Because
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: 103 Country Club Dr, Fayetteville, NC 28301 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 oppo
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. Title: Medical Scribe Company: Oak Street Health Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. <
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. Requisition Job Description Job Description Company: Oak Street Health Title: Medical Scribe (Full-time in Primary Care Setting) Role Description The purpose of a Medical Scribe at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and t
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. Title: Medical Scribe Company: Oak Street Health Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. <
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
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 - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication
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 Reporting to the Finance Director, this position (Sr Accountant) assists in the preparation of financial statements, journal entries and supporting documentation specifically for Federal Grants and Non-Title funds from the State of AZ. This position’s responsibilities include, but are not limited to, preparing regulatory reports, recording detailed transactions, analyzing variances in the general ledger, and reconciling cash and balance sheet accounts. Incumbent will cross-train to support various accounting and finance functions. Primary Job Duties & Responsibilities: Complete all necessary analysis and research for federal grants and monthly grant invoice review (CER’s) and financial statement reporting, balance sheet reconciliation and journal entries by utilizing Excel, QuickBase, banking information and the Great Plains Accounting System. Complete weekly Research related to provider invoices for grant funding and work closely with the providers for required grant support and reporting. Complete monthly wires for provider payments that require entering the payment into QuickBase including the calculation support for approval. Prepare regulatory reports adhering to all contractual reporting obligations to our regulatory agent on a monthly/quarterly and annual basis per the reporting guide from Mercy Care regulators (AHCC
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. Title: Medical Scribe Company: Oak Street Health Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. <
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. Title: Medical Scribe Company: Oak Street Health Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. <p
Become a part of our caring community The Counsel provides a full range of legal advice and services on litigation, arbitration, and related legal matters and strategy. The Counsel will collaborate internally and with outside counsel on case strategy, discovery, and resolution of disputes. The Counsel will exercise independent judgment and decision-making on litigation issues and related tasks and work under modest supervision. This role requires applying in-depth and broad knowledge of litigation practices, frequently taking full ownership of legal matters, and organizing and managing individual litigation matters from inception through trial. Use your skills to make an impact Required Qualifications Juris Doctor degree from an ABA-accredited law school Active and licensed membership in a state bar association At least 4 years of experience in litigation Strong project management and organizational skills across all facets of litigation from inception through trial Ability to organize and successfully manage a number of case matters simultaneously Strong skills in communicating complex legal issues to various stakeholders Ability to mitigate risk by acting as a trusted advisor whose strategic thinking, pragmatic problem-solving, and proactive counsel are sought by clients Ability to work independently under general supervision and in team settings Experience with large-scale e-discovery Preferred Qualifications Experience with provider disputes and healthcare reimbursement disputes Experience with alternative dispute resolution (ADR), including arbitration Understanding of Medicaid/Medicare laws and regulations Work at Home Requirements:
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Position Overview: Working on the Oncology Sales team, the Sr. Regional Oncology Specialist (Sr. ROS) will develop and implement a plan to maximize the utilization of Abbott Cancer Diagnostics products in targeted accounts, while staying within budget, and support the corporate objectives and highlight the delivery of key selling messages. Products may include OncoExTra, OncoDetect (MRD) and RiskGuard (Hereditary Cancer Testing). The Sr. ROS should incorporate a high level of service toward being the best-in-class for an assay provider. The Sr. ROS’s plans are used to solve challenging problems in a dynamic environment. The plans should emphasize developing customer relationships as well as leveraging strong clinical and scientific expertise, key stakeholder insight, and selling approach in highly competitive and complex market. To do this plan, the Lead ROS must have, or be able to quickly develop, a clear understanding of key territory-related clinical/political issues. The Sr. ROS will devote whatever time is necessary to complete objectives outlined in the sales plan. The Sr. ROS provides information critical to accomplishing our mission to all parties involved in the sales of products. The Sr. ROS will provide direct feedback to individuals so they can make accurate decisions at all levels of the company, such as national, regional, and area teams. The Sr. ROS will work with managed care, reimbursement, patients, to include patient support groups, Abbott Cancer Diagnostics advocacy group, and providers to
$98.4K – $147.6K/yr
What if the work you did every day could impact the lives of people you know? Or all of humanity? At Illumina, we are expanding access to genomic technology to realize health equity for billions of people around the world. Our efforts enable life-changing discoveries that are transforming human health through the early detection and diagnosis of diseases and new treatment options for patients. Working at Illumina means being part of something bigger than yourself. Every person, in every role, has the opportunity to make a difference. Surrounded by extraordinary people, inspiring leaders, and world changing projects, you will do more and become more than you ever thought possible. Position Summary: The Senior Informatics Sales Specialist will use their strong genomics, healthcare and Informatics technical knowledge and expertise to identify and close Informatics opportunities. This involves selling to prospective customers and Illumina colleagues on Next Generation Sequencing and Genomic data analysis pipelines, applications and products primarily for use in clinical research or testing. They will act as an influencer and expert resource for customers and others to ensure success while enabling sales growth through strategic activities and creative problem solving. The Informatics Sales Specialist should be viewed as a “go to” subject matter expert for all things Informatics, with primary focus on Illumina’s clinical software products. As an Informatics Sales Specialist, you are impacting clinical data analysis and interpretation through effective engagement with C-level executives, Laboratory Directors, Healthcare practitioners, IT leaders, and data analysts. You are establishing Illumina as a prominent cloud-based enterprise platform provider to the Clinical, Pharma, and Healthcare se
From $224K/yr
Zscaler (NASDAQ: ZS) accelerates digital transformation so customers can be more agile, efficient, resilient, and secure. The Zscaler Zero Trust Exchange™️ platform protects thousands of customers from cyberattacks and data loss by securely connecting users, devices, and applications in any location. Distributed across 160+ public exchanges globally and thousands of private exchanges at the edge, the SASE-based Zero Trust Exchange is the world’s largest in-line cloud security platform. We believe the future of work is Human + AI and are building an AI-native enterprise where human potential is amplified by machine intelligence to solve the world’s hardest security challenges. Driven by deep customer obsession, we are committed to the mission, outcome, and to each other. We bring these commitments to life through three core behaviors: ownership and collaboration, trust through outcomes and impact, and a challenge culture with ongoing feedback. Ready to make an impact at the company pioneering security transformation in the AI era? Join us at Zscaler. The Zscaler Sales and Go-to-Market team is a global group of professionals who are passionate about delighting our customers, nurturing trusted partnerships, and sharing their expertise to drive a secure, cloud-enabled digital future and further cement our position as the world leader in cloud security. Sales, Customer Success, Sales Enablement, Solution Architects, Business Development, Transformation, and Technology Partnerships all work together to demonstrate the power and agility of Zscaler cloud transformation to the world. We're looking for an experienced Healthcare Provider CISO/CTO to join our team sitting in the West region. Reporting to our Healthcare Strategic Leader, you'll manage the following: You will be Zscaler's technical executive sponsor with the largest healthcare providers and make technology decisions on behalf of the organization You will provide technical leadership and serve a necessary r
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