Information Technology For Development Jobs in Pullman Washington Remote
1,886 positions found — Page 91
JOB DESCRIPTION
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments.
• Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
• Conducts telephonic, face-to-face or home visits as required.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
• 15% estimated local travel may be required (based upon state/contractual requirements).
Required Qualifications
• At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA).
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications
• Certified Case Manager (CCM).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
#PJHS
#LI-AC1
Pay Range: $25.08 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Remote working/work at home options are available for this role.
**** Candidates must reside in New York.*****
JOB DESCRIPTION Job Summary
Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Responsible for leading and managing performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collates and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.
• Ensures completion of staff quality audit reviews; evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
•At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• At least 1 year of health care management/leadership experience.
• Must be a Registered Nurse (RN), Clinical licensure and/or certification required ONLY if required by state contract (Preferably New York), regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Experience working within applicable state, federal, and third party regulations.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Medicaid/Medicare population experience.
• Clinical experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $73,102 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Remote working/work at home options are available for this role.
Investment Operations Analyst - Investment Management
We are currently seeking candidates for a Portfolio Administrator opportunity with an elite Investment Management firm located in Miami, FL. The Portfolio Administrator will conduct portfolio accounting, support trade operations, perform reconciliations, and promote strong vendor relations. The ideal candidate will have 3+ years of investment operations, portfolio administration, and reconciliations experience in investment management or financial services industry.
This is a direct-hire opportunity offering a salary of $75,000–$85,000 (depending on experience) and operating under either a hybrid or fully remote work model, based out of Boston, MA.
Responsibilities:
- Maintain and validate cash transactions through accurate data entry in the portfolio accounting system.
- Manage trade data flow from trading desks, ensuring settlement details are received, verified, and properly recorded.
- Oversee the seamless integration of trade information into the accounting platform and ensure timely reporting to custodians.
- Support the maintenance of securities master data, including accurate security attributes and market pricing for reliable valuation and performance reporting.
- Perform daily reconciliations of holdings and transactions across internal systems and custodian records, documenting and promptly resolving discrepancies.
- Generate and distribute reconciliation reports for internal teams and external stakeholders using various system tools.
- Produce standard and ad hoc reports to support internal operations and meet external client or regulatory requirements.
- Build and maintain strong relationships with vendors, custodians, and financial institutions, proactively addressing service issues and monitoring industry developments.
Qualifications:
- Bachelor's degree in Finance, Economics, or Business.
- 3+ years of experience in investment operations, with a strong focus on reconciliations.
- Proficiency with Microsoft Excel for data analysis and reporting.
- Solid understanding of fixed income and equity securities.
- Exceptional analytical thinking, problem-solving abilities, and organizational skills.
- Outstanding written and verbal communication skills, with the ability to efficiently manage a high volume of email correspondence.
- Capable of working independently with minimal supervision, while also thriving in a collaborative remote or hybrid team environment.
For immediate consideration, interested and qualified candidates should send their resume to Lydia at .
Remote working/work at home options are available for this role.
LHH is seeking a Senior Databricks AI/ML Engineer to join our client's team in a fully remote role based in Seattle, WA. Candidates must live in one of the following states, and be prepared to pass a background check/identity verification process: WA, OR, ID, OH, SC, NC, TX, or FL
LHH has a dynamic and challenging opportunity for a Senior Databricks AI/ML Engineer to join our client's engineering team. This role focuses on building and deploying scalable AI/ML solutions across key areas of the insurance functions, including underwriting, claims, pricing, customer engagement, and fraud detection, with a strong emphasis on Databricks architecture and ecosystem integration. The engineer will collaborate closely with data scientists, actuaries, product owners, and engineers to operationalize models, transforming them into robust, production-grade systems seamlessly integrated into business workflows and enterprise platforms.
Salary & Benefits:
- $150k to $185k annually (depending on location & experience)
- Medical, dental, and vision insurance
- 401(k) plan with employer match
- Vacation time accrues at a rate of 10 days annually, with increases based on a tenure schedule, up to a maximum of 25 days per year.
- PTO included Four (4) personal days are granted immediately upon hire.
- Paid holidays are provided for the eight (8) holidays observed in this role throughout the calendar year.
- Up to ten (10) days of sick leave are granted immediately upon hire (pro-rated based on hire date and full-time/part-time status).
- Additional paid time off is available for bereavement, jury duty, and employee volunteer activities in the community.
- Life and disability insurance
Minimum Qualifications:
- Bachelor's degree in Computer Science, AI/ML, Data Science/Engineering, or related field (or equivalent experience).
- 6+ years experience in ETL pipelines, SQL Server, and production data workflows.
- 3+ years enterprise experience with Azure & Databricks AI/ML, including data analysis and visual analytics.
- 3+ years applying ML algorithms and transforming data science prototypes into production.
- 5+ years experience with CI/CD workflows for ML models and related code.
- Strong SQL, real-time and batch data pipeline development, and unsupervised learning techniques.
- Familiarity with agile methodologies (e.g., Scrum).
Responsibilities:
- Conduct customer workshops to gather requirements and design analytics architectures using Azure and Databricks AI/ML.
- Serve as Databricks Architect, managing workspace design, deployment, and governance across environments.
- Define and implement Databricks Lakehouse architecture and governance best practices.
- Integrate Databricks with Azure services and lead implementation of Databricks SQL, Delta Live Tables, and MLflow.
- Develop and maintain automated MLOps workflows for model deployment, monitoring, and lifecycle management.
- Set up and configure Azure and Databricks infrastructure for AI/ML workloads.
- Review ML model code and analytics scripts for quality and performance.
- Design and build data pipelines and cloud services for monitoring, analysis, and reporting.
- Develop robust ETL workflows using Databricks, Spark, and SQL Server for structured and unstructured data.
- Provide production support and performance tuning for data engineering workflows.
- Optimize complex SQL queries and stored procedures for data processing and business logic.
- Collaborate with cross-functional teams to ensure data quality and support business decision-making.
- Scale and deploy machine learning models to handle large-scale data.
- Feed raw data into models and build deployment pipelines for new models.
- Implement logging, observability, and performance monitoring for AI/ML systems.
- Conduct architecture reviews and performance testing.
- Perform other duties as assigned.
Preferred Qualifications:
- Master's degree in a related field.
- Experience in the insurance industry (Auto, Home, Umbrella) and related AI/ML applications.
- Proficiency with tools/platforms: Azure ML, Databricks, Microsoft Fabric, Synapse, Power BI, Snowflake, and APIs like Azure OpenAI and Cognitive Services.
- Knowledge of streaming frameworks: Apache Kafka, Azure Event Hubs, Delta Live Tables.
- Strong math, problem-solving, and rapid learning skills.
- Excellent communication, organization, and independent work capabilities.
- Service-oriented mindset with ability to handle ambiguity and build strong relationships.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance
Remote working/work at home options are available for this role.
Our for-profit education client is building an overflow studio team to support their internal creative and marketing team. We are looking for TWO Sr. Project Coordinators to support the various marketing campaigns, including trafficking creative deliverables.
Must be in either EST or CST.
Position #1: This position is up to 20-30 hours a week and fully remote through the end of 2026 with the potential to extend.
Position #2: This position is up to 20 hour a week and fully remote for 3-4 months with the potential to extend.
PLEASE SPECIFY WHICH POSITION YOU ARE INTERESTED IN OR IF YOU ARE COMFORTABLE WITH EITHER.
The ideal candidate has a background in marketing and has a strong understanding of the timelines and deliverables needed to create and execute omnichannel marketing campaigns.
You MUST have your own workstation/equipment.
The Sr. Project Coordinator will:
- Manage project timelines, schedules, and deliverables - ensure deadlines are met and escalate roadblocks/approvals as needed
- Review tickets submitted through the client's project management software and forwarded to the appropriate person
- Review project briefs and deliverables list to confirm necessary details are provided before kickoff meeting
- Schedule team meetings, prepare agendas, distribute notes and next steps
Traffic creative deliverables for approvals - Ensure compliance of brand guidelines and legal requirements are met for deliverables
- Assist with the development of project schedules and ensure schedules are input into the project management tool
- Assist the program manager with resource alignment
- Manage the delivery of assets and client revisions to ensure deadlines are met
Handle data entry and admin duties for the marketing and creative departmentThe Sr. Project Coordinator must have:- Bachelor's degree in marketing, communications, etc
- A minimum of 4 years of experience assisting with the coordination of various projects
- Experience working with a robust project management tool i.e. RoboHead, Asana, Basecamp
- Knowledge of marketing campaigns and creative collateral
- Certification in project management is a plus
Email Your Resume In Word To
Looking forward to receiving your resume through our website and going over the position with you. Clicking apply is the best way to apply.
Please do NOT change the email subject line in any way. You must keep the JobID: linkedin : AG24-1980299 -- in the email subject line for your application to be considered.
Allie Gribble - Senior Solutions Delivery Recruiter
For Creative Circle to represent you for this opportunity, you must be currently authorized to work in the United States without the need of employer sponsorship for a non-immigrant visa such as a H-1B, TN, or O visa. We do not support or provide training for STEM/OPT programs. Additionally, you must be physically located in and perform the work for our client in the United is a new role.
This job was first posted by Creative Circle on 03/11/2026 and applications will be accepted on an ongoing basis until the position is filled or closed.
This job was posted on 03/11/2026 and is open for 60 days
Creative Circle is an Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity or expression, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, or any other characteristic protected by law. Our hiring process includes AI screening for keywords and minimum qualifications. Recruiters review all results. Creative Circle will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable state and local law, including but not limited to the Los Angeles County Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, and the California Fair Chance Act. If you need a reasonable accommodation in the application process, please contact your Recruiter (the person you'll be interviewing with) or a member of our Human Resources team to make arrangements. United Healthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Creative Circle.
Copyright 1999 - 2026. CreativeCircle , Inc. All rights reserved.
Remote working/work at home options are available for this role.
Location: Northern Chicagoland Suburbs (mostly remote, onsite 2-4 times per month)
Duration: Full Time/Direct Hire + 10% Bonus Opportunity
Position Overview:
Our client, a growing leader in the CPG space, is seeking a hands-on Digital Design Manager to join their expanding creative team. This is an exciting opportunity for a digital-first creative leader who enjoys balancing big-picture concepting with day-to-day execution. In this role, you will directly manage a team of three designers while driving creative excellence across multiple consumer brands.
The ideal candidate is conceptual, detail-oriented, and passionate about producing engaging digital and social content.
Responsibilities:
- Lead, mentor, and guide a team of designers, providing creative direction, feedback, and professional development support
- Concept and execute digital-first creative across video, e-commerce, paid and organic social, display advertising, email, websites, static assets, and animated content
- Develop storyboards, motion concepts, and visual directions for video and animation
- Collaborate closely with marketing partners to create on-brand visual content that communicates product features and brand messaging
- Stay current on design trends, digital best practices, emerging tools, and AI capabilities
- Manage multiple projects at once while meeting deadlines and maintaining high creative standards
- Ensure brand consistency and adherence to brand guidelines across all deliverables
- Build and maintain strong relationships with internal stakeholders and creative partners
Requirements:
- 8+ years of experience in digital design or art direction, with strong digital and social content experience
- 2+ years of experience managing or leading direct reports
- Strong portfolio featuring digital and social work, including examples from the CPG space
- Advanced skills in Adobe Creative Suite (Photoshop, Illustrator, InDesign)
- Familiarity with AI tools and the ability to prompt for concepting or visual exploration
- Strong communication, organization, and project management skills
Why This Role Stands Out:
- Opportunity to join a growing creative team within a fast-moving CPG company
- Balance of creative leadership and hands-on design
- Collaborative environment with room to innovate and experiment
- Flexible hybrid schedule with minimal onsite requirements
In this position, you may have access to client or customer systems, confidential and/or proprietary information or data. This position is onsite and requires you to work closely with other individuals in a collaborative team environment.
Benefits
Flexible work options (fully remote, hybrid, onsite)
Generous paid time off
Bonus incentives
401K company match
Competitive medical, dental, & vision insurance
Pet insurance
Annual fitness stipend
Unmatched employee discount on all products
Summer Hours
Email Your Resume In Word To
Looking forward to receiving your resume through our website and going over the position with you. Clicking apply is the best way to apply.
Please do NOT change the email subject line in any way. You must keep the JobID: linkedin : AB19-1980130 -- in the email subject line for your application to be considered.
Amy Banks - Senior Recruitment Manager
For Creative Circle to represent you for this opportunity, you must be currently authorized to work in the United States without the need of employer sponsorship for a non-immigrant visa such as a H-1B, TN, or O visa. We do not support or provide training for STEM/OPT programs. Additionally, you must be physically located in and perform the work for our client in the United is a new role.
This job was first posted by Creative Circle on 03/10/2026 and applications will be accepted on an ongoing basis until the position is filled or closed.
Creative Circle is an Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity or expression, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, or any other characteristic protected by law. Our hiring process includes AI screening for keywords and minimum qualifications. Recruiters review all results. Creative Circle will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable state and local law, including but not limited to the Los Angeles County Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, and the California Fair Chance Act. If you need a reasonable accommodation in the application process, please contact your Recruiter (the person you'll be interviewing with) or a member of our Human Resources team to make arrangements. United Healthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Creative Circle.
Copyright 1999 - 2026. CreativeCircle , Inc. All rights reserved.
Remote working/work at home options are available for this role.
The Trainer, Revenue Integrity is responsible for developing and delivering training programs that support accurate and compliant revenue cycle processes. This role ensures that staff across departments understand and adhere to revenue integrity standards, including coding, billing, documentation, and compliance requirements. The trainer collaborates with subject matter experts to create educational materials and evaluates training effectiveness to drive continuous improvement.
Experience:
- Minimum of 3-5 years of experience in healthcare revenue cycle, coding, billing, or compliance
- Experience in developing and delivering training programs
- Familiarity with CMS regulations, payer guidelines, and healthcare compliance standards
- Strong communication, presentation, and instructional design skills
Education:
- Bachelor’s degree in Healthcare Administration, Health Information Management, or related field (required)
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification (preferred)
Key Roles and Responsibilities:
1. Design and deliver training programs on revenue integrity topics including coding, billing, and documentation.
2. Assess training needs through surveys, audits, and performance data.
3. Develop educational materials such as manuals, presentations, and e-learning modules.
4. Conduct onboarding training for new hires and ongoing education for existing staff.
5. Collaborate with compliance and revenue cycle teams to ensure training aligns with current regulations.
6. Monitor and evaluate training effectiveness and make improvements as needed.
7. Maintain training records and documentation for compliance purposes.
8. Serve as a subject matter expert on revenue integrity practices.
9. Provide one-on-one coaching and support to staff as needed.
10. Stay current with industry trends, regulatory changes, and best practices in revenue integrity.
Other Duties:
1. Educating caregivers on functionality or workflow
2. Remaining current with industry standards and events that may significantly impact reimbursement.
Upload 9-22-25
Remote working/work at home options are available for this role.
This role plays a key part in ensuring maternity care bills are processed accurately and members receive timely support during an important season of life. The specialist serves as a detail-oriented professional who upholds CHM’s commitment to excellence, compassion, and integrity.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
ESSENTIAL JOB FUNCTIONS
- Compile, verify, and organize information according to priorities to prepare data for entry
- Check for duplicate records before processing
- Accurately enter medical billing information into the company’s software system
- Research and correct documents submitted with incomplete or inaccurate details
- Verify member information such as enrollment date, participation level, coverage status, and date of service before processing medical bills
- Review data for accuracy and completeness
- Uphold the values and culture of the organization
- Follow company policies, procedures, and guidelines
- Verify eligibility in accordance with established policies and definitions
- Identify and escalate concerns to leadership as appropriate
- Maintain daily productivity standards
- Demonstrate eagerness and initiative to learn and take on a variety of tasks
- Support the overall mission and culture of the organization
- Perform other duties as assigned by management
SKILLS & COMPETENCIES
- Core strengths like problem-solving, attention to detail, adaptability, collaboration, and time management.
- Soft skills such as empathy (especially important in maternity care), professionalism, and being able to handle sensitive information with care.
EXPERIENCE REQUIREMENTS
- Required: High school diploma or passage of a high school equivalency exam
- Medical background preferred but not required.
- Capacity to maintain confidentiality.
- Ability to recognize, research and maintain accuracy.
- Excellent communication skills both written and verbal.
- Able to operate a PC, including working with information systems/applications.
- Previous experience with Microsoft Office programs (I.e., Outlook, Word, Excel & Access)
- Experience operating routine office equipment (i.e., faxes, copy machines, printers, multi-line telephones, etc.)
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
Remote working/work at home options are available for this role.
The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to support eligibility determinations and alternative treatment evaluations in alignment with Christian Healthcare Ministries’ guidelines and values. This role exists to ensure medical review decisions are accurate, evidence-based, and applied consistently while maintaining compassion and clarity in member interactions.
At the highest level, the Medical Review Specialist focuses on clinical analysis, guideline interpretation, and professional judgment, supporting sound decision-making that upholds CHM’s mission, stewardship, and commitment to member care.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
PRIMARY RESPONSBILITIES
- Review and analyze complex medical records to assess eligibility, appropriateness of services, and alignment with CHM medical guidelines.
- Apply clinical judgment and established criteria to support consistent, evidence-based eligibility determinations.
- Conduct medical literature reviews and research to support recommendations, alternative treatment considerations, and guideline application.
- Collaborate with the Eligibility Review Supervisor, Medical Director, and Medical Review leadership to ensure alignment and consistency in medical review decisions.
- Communicate clearly and compassionately with members and internal teams regarding medical review outcomes, addressing questions and concerns professionally.
- De-escalate sensitive or emotionally charged interactions while maintaining CHM standards and values.
- Maintain accurate documentation of medical review findings, rationale, and decisions within CHM systems.
- Stay current on medical research, industry standards, and regulatory considerations relevant to medical review activities.
- Uphold strict confidentiality and HIPAA compliance in all handling of protected health information.
CORE COMPETENCIES & SKILLS
- Medical analysis and critical thinking – Interpret complex medical information and applies clinical reasoning.
- Evidence-based decision making – Utilizes research and guidelines to support review outcomes.
- Clear and compassionate communication – Explains medical determinations in an understandable and empathetic manner.
- Case management and prioritization – Manages multiple cases while meeting accuracy and timeliness standards.
- Documentation and compliance – Maintain thorough, accurate records aligned with regulatory and internal requirements.
- Collaboration – Works effectively with leadership, medical reviewers, and cross-functional teams.
REQUIRED QUALIFICATIONS & CONSIDERATIONS
Education
- Bachelor’s degree in a healthcare-related field (e.g., nursing, health sciences, biology) preferred.
- Equivalent clinical or medical review experience may be considered in lieu of a degree.
Experience
- Prior experience in medical record review, utilization review, clinical review, or a related healthcare role preferred.
- Experience applying medical guidelines or clinical criteria to eligibility or treatment determinations strongly preferred.
- Familiarity with HIPAA regulations and protected health information handling required.
- Experience working with EMR/EHR systems, medical coding, or health information systems is a plus.
Certifications
- No certifications required at time of hire.
- Clinical licensure or healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required.
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
Remote working/work at home options are available for this role.
12 month Contract role with potential to go permanent
Fully remote for now possible but possibility to turn Hybrid in office 2 days a week in Durham come January 2027 MUST live within a commutable distance to Durham
M-F 9-5 EST hours, can live in other time zones but work those EST hours
*Call Center, PBM, or Retail experience
*Must have an understanding of Medicare STARS and Metrics
*Must be comfortable on the phones interacting with members
*Must have experience working remotely
- Make outreach to Medicare members to assist in removing barriers to medication adherence.
- Partner with pharmacies and providers to close adherence gaps when the Medicare member is unengaged or when the Medicare member requires assistance.
- Contact providers to close SUPD (Statin Use in Persons with Diabetes) gaps.
- Complete Comprehensive Medication Reviews (CMRs) with eligible Medicare members to give the member a better understanding of their medications and health.
- Send interventions to providers through fax or the CMR platform to alert the provider of potential drug interactions and adverse reactions, dose changes, adherence issues, etc.
- Provide counseling to Medicare members regarding medications.
- Provide Medicare members with information regarding their pharmacy benefits (ie. formulary, preferred pharmacy, supplemental benefits, etc.)
- Provide clinical guidance and support to the Pharmacy Quality Specialists
Hiring Requirements
• PharmD
• 3+ years of experience in related field.
• North Carolina pharmacy license.
Remote working/work at home options are available for this role.
