1 in 4 people in the US have a treatable mental health condition, but most providers don’t accept insurance, making therapy too expensive for most people. Headway’s mission is to...

TFS HealthScience is a leading global mid-size Contract Research Organization (CRO) that partners with biotechnology and pharmaceutical companies throughout their entire clinical development journey.

Ankura is a team of excellence founded on innovation and growth.

The range for this role is $31.97 per hour to $43.51 per hour

Actual base pay will be determined based on a successful candidate’s work location, skills/abilities, experience, and education.

Interested applicants must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability.

The Job

The Senior Clinical Reviewer works to summarize and correlate concise, accurate information on medical reviews to determine eligibility of medical bills per the program guidelines. In this role, 70% of the time is spent performing pre-service and post-service medical reviews and/or reviews for high dollar, complex medical cases and collaborating with other departments to optimize cost savings.  This position leverages AI-enabled clinical review tools and electronically ingested data (278 transactions) to enhance the accuracy, efficiency, and consistency of medical reviews.  The Senior Clinical Reviewer will be expected to make decisions regarding timing and omission of medical reviews in deference to other department processes based on the dollar amount of the bill and the Ministry’s cost strategy.

Essential Job Duties & Responsibilities

• Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF’s)
• Determine eligibility of members’ medical bills and/or upcoming procedures/treatments according to the program guidelines
• Perform pre-service and post-service medical reviews utilizing AI-enabled clinical review tools to make evidence-based, consistent, and efficient determinations of sharing eligibility
• Review and interpret pre-service eligibility data (via 278 EDI transactions) to support streamlined medical review workflows
• Integrate structured electronic data with clinical documentation to support accurate and timely eligibility determinations
• Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members
• Appropriately apply the program guidelines to the individual cases reviewed
• Work autonomously to prioritize and manage workload
• Document effectively in appropriate systems, including outputs supported by AI tools and electronic data ingestion processes
• Comply with all organizational HIPAA requirements and ensure proper handling of electronic transaction data
• Support process improvements related to automation, using AI tools and electronic data ingestion workflows
• Contribute to the exercise and expression of the Ministry’s Christian beliefs
• All other duties as assigned

Essential Skills & Abilities

• Understanding of medical bill processing and provider bill negotiation
• Knowledge and practical application of AI-assisted medical review tools and clinical decision support technologies
• Ability to understand Availity 278 transactions and electronic pre-service eligibility workflows
• Ability to interpret structured electronic data and integrate it with clinical documentation during the medical review process
• Ability to multitask in multiple operating systems
• Ability to work for extended periods of time on the computer
• Proficiency in interpreting medical records and writing detailed reports and conclusions
• Strategic understanding of negotiations, third party processes, bill validation, and care management to determine when to utilize/defer to these processes for active review cases
• Ability to be objective and impartial and conclude a case
• Ability to communicate effectively with both internal and external customers
• Interpersonal skills and ability to work as a member of a team
• Ability to adapt to changing processes
• Working knowledge and application of program guidelines
• Understanding of systems and workflows as they relate to the type of review or assignment
• Ability to utilize the internet including e-mail and search engines
• Word processing skills of at least 25 wpm
• Basic knowledge in Microsoft Office (Excel, Word, Outlook, Teams) and ability to use a database system
• Knowledge of document imaging system

Core Competencies/Demonstrable Behaviors

• Action Oriented – taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm
• Plans and aligns – planning and prioritizing work to meet commitments aligned with organizational goals
• Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose.  This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction.  Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
• Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
• Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence.  Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
• Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Education and/or Experience

• Current Unrestricted LPN/LVN license with 5+ years’ experience in a healthcare payer industry or RN license with sound knowledge of anatomy and physiology and disease processes
• 1-3 years’ experience in medical reviews required
• 2-3 years of clinical experience strongly preferred
• Experience with Utilization Review or Case Management preferred

Supervisory Responsibilities

• This job has no supervisory responsibilities

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

• 100% paid Medical for employees/99% for family
• Generous employer Health Savings Account (HSA) contributions
• Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
• 6 weeks of paid parental leave (for both mom and dad)
• Dental - two plans to choose from
• Vision
• Short-term Disability
• Accident, Critical Illness, Hospital Indemnity
• 401(k) – up to 4% match on ROTH or Traditional contributions
• Generous paid-time off and 11 paid holidays
• Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
• Employee Assistance Program including no cost, in-person mental health visits and employee discounts
• Monetary Anniversary Awards Program
• Monetary Birthday Awards
• Tuition Reimbursement Program

Minimum Age Requirement: Due to the nature of the responsibilities associated with this position—including independent decision-making, access to confidential information, and potential exposure to regulated environments—candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

The range for this role is $31.97 per hour to $43.51 per hour

Actual base pay will be determined based on a successful candidate’s work location, skills/abilities, experience, and education.

Interested applicants must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability.

The Job

The Senior Clinical Reviewer works to summarize and correlate concise, accurate information on medical reviews to determine eligibility of medical bills per the program guidelines. In this role, 70% of the time is spent performing pre-service and post-service medical reviews and/or reviews for high dollar, complex medical cases and collaborating with other departments to optimize cost savings.  This position leverages AI-enabled clinical review tools and electronically ingested data (278 transactions) to enhance the accuracy, efficiency, and consistency of medical reviews.  The Senior Clinical Reviewer will be expected to make decisions regarding timing and omission of medical reviews in deference to other department processes based on the dollar amount of the bill and the Ministry’s cost strategy.

Essential Job Duties & Responsibilities

• Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF’s)
• Determine eligibility of members’ medical bills and/or upcoming procedures/treatments according to the program guidelines
• Perform pre-service and post-service medical reviews utilizing AI-enabled clinical review tools to make evidence-based, consistent, and efficient determinations of sharing eligibility
• Review and interpret pre-service eligibility data (via 278 EDI transactions) to support streamlined medical review workflows
• Integrate structured electronic data with clinical documentation to support accurate and timely eligibility determinations
• Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members
• Appropriately apply the program guidelines to the individual cases reviewed
• Work autonomously to prioritize and manage workload
• Document effectively in appropriate systems, including outputs supported by AI tools and electronic data ingestion processes
• Comply with all organizational HIPAA requirements and ensure proper handling of electronic transaction data
• Support process improvements related to automation, using AI tools and electronic data ingestion workflows
• Contribute to the exercise and expression of the Ministry’s Christian beliefs
• All other duties as assigned

Essential Skills & Abilities

• Understanding of medical bill processing and provider bill negotiation
• Knowledge and practical application of AI-assisted medical review tools and clinical decision support technologies
• Ability to understand Availity 278 transactions and electronic pre-service eligibility workflows
• Ability to interpret structured electronic data and integrate it with clinical documentation during the medical review process
• Ability to multitask in multiple operating systems
• Ability to work for extended periods of time on the computer
• Proficiency in interpreting medical records and writing detailed reports and conclusions
• Strategic understanding of negotiations, third party processes, bill validation, and care management to determine when to utilize/defer to these processes for active review cases
• Ability to be objective and impartial and conclude a case
• Ability to communicate effectively with both internal and external customers
• Interpersonal skills and ability to work as a member of a team
• Ability to adapt to changing processes
• Working knowledge and application of program guidelines
• Understanding of systems and workflows as they relate to the type of review or assignment
• Ability to utilize the internet including e-mail and search engines
• Word processing skills of at least 25 wpm
• Basic knowledge in Microsoft Office (Excel, Word, Outlook, Teams) and ability to use a database system
• Knowledge of document imaging system

Core Competencies/Demonstrable Behaviors

• Action Oriented – taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm
• Plans and aligns – planning and prioritizing work to meet commitments aligned with organizational goals
• Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose.  This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction.  Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
• Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
• Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence.  Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
• Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Education and/or Experience

• Current Unrestricted LPN/LVN license with 5+ years’ experience in a healthcare payer industry or RN license with sound knowledge of anatomy and physiology and disease processes
• 1-3 years’ experience in medical reviews required
• 2-3 years of clinical experience strongly preferred
• Experience with Utilization Review or Case Management preferred

Supervisory Responsibilities

• This job has no supervisory responsibilities

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

• 100% paid Medical for employees/99% for family
• Generous employer Health Savings Account (HSA) contributions
• Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
• 6 weeks of paid parental leave (for both mom and dad)
• Dental - two plans to choose from
• Vision
• Short-term Disability
• Accident, Critical Illness, Hospital Indemnity
• 401(k) – up to 4% match on ROTH or Traditional contributions
• Generous paid-time off and 11 paid holidays
• Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
• Employee Assistance Program including no cost, in-person mental health visits and employee discounts
• Monetary Anniversary Awards Program
• Monetary Birthday Awards
• Tuition Reimbursement Program

Minimum Age Requirement: Due to the nature of the responsibilities associated with this position—including independent decision-making, access to confidential information, and potential exposure to regulated environments—candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

Role Title: Senior Hospitalist Clinical Reviewer Role Type: Contractor Location: Remote micro1 is engaging Senior Hospitalist Clinical Reviewers to contribute to a high-impact project with a customer focused on inpatient quality and documentation.

DescriptionRemote | 1099 Independent Contractor | Flexible Commitment MEDvidi is seeking experienced Physicians (MD/DO) to serve as Collaborating / Supervising Physicians for our growing team of Psychiatric Mental Health Nurse Practitioners (PMHNPs).

Job Title: Speech-Language Therapist (SLT)

Location: St. Stephens Indian School

Work Schedule: 4 days per week, 7 hours per day

Key Responsibilities:

• Conduct speech and language assessments to identify communication deficits in students, including articulation, fluency, voice, and language disorders.
• Provide direct speech/language therapy to students on a regular basis, adjusting interventions to meet evolving needs.
• Collaborate with special education and classroom teachers to advise on speech therapy strategies and carryover techniques for use in the classroom and home environments.
• Communicate effectively with parents, teachers, and outside professionals to support student progress and service coordination.
• Maintain detailed and accurate documentation including evaluations, progress notes, contact logs, and treatment plans.

Minimum Qualifications:

• Current, active, full, and unrestricted license as a Speech-Language Therapist issued by a U.S. state, DC, Puerto Rico, or U.S. territory.
• Master’s degree in Speech-Language Pathology from an accredited institution recognized by the U.S. Department of Education.
• Minimum of 5 years’ experience providing speech-language therapy services within a school setting, demonstrating ability to independently manage evaluations, testing, and report writing under IEP and IDEA guidelines.

Job Title: Speech-Language Therapist (SLT)

Location: Remote. St. Stephens Indian School

Work Schedule: Remote - 4 days per week, 7 hours per day

Key Responsibilities:

• Conduct speech and language assessments to identify communication deficits in students, including articulation, fluency, voice, and language disorders.
• Provide direct speech/language therapy to students on a regular basis, adjusting interventions to meet evolving needs.
• Collaborate with special education and classroom teachers to advise on speech therapy strategies and carryover techniques for use in the classroom and home environments.
• Communicate effectively with parents, teachers, and outside professionals to support student progress and service coordination.
• Maintain detailed and accurate documentation including evaluations, progress notes, contact logs, and treatment plans.

Minimum Qualifications:

• Current, active, full, and unrestricted license as a Speech-Language Therapist issued by a U.S. state, DC, Puerto Rico, or U.S. territory.
• Master’s degree in Speech-Language Pathology from an accredited institution recognized by the U.S. Department of Education.
• Minimum of 5 years’ experience providing speech-language therapy services within a school setting, demonstrating ability to independently manage evaluations, testing, and report writing under IEP and IDEA guidelines.

POSITION SUMMARY 100% Remote: Body Imaging Radiologist (Oncology Focused).

Company Description

PSI is a leading Contract Research Organization with more than 30 years in the industry, offering a perfect balance between stability and innovation to both clients and employees.  We focus on delivering quality and on-time services across a variety of therapeutic indications.

Job Description

PSI Medical Monitors provide medical input to global clinical studies and advise the teams and business partners, while always focusing on patients’ safety and well-being.

Home-Based in United States

Responsibilities:

• Acts as the primary point of contact for all parties on all trial-specific medical and safety-related questions
• Provides input for responses to regulatory authorities and Institutional Review Boards (IRBs)/Independent Ethics Committees (IECs) on trial-specific medical and safety-related questions
• Monitors trial participant safety
• Participates in trial participant recruitment boost and retention activities
• Presents on medical matters at kick-off and investigator meetings
• Trains trial team in the therapeutic area and medical aspects of the protocol
• Develops and reviews trial-specific documents within the scope of medical monitoring
• Manages ongoing trial risks related to medical monitoring
• Performs ongoing medical review of the operational clinical trial database; provides support to Medical Reviewer(s) assigned to the trial
• Reviews protocol deviations
• Reviews RAE reports, writes and/or reviews SAE narratives, supports Pharmacovigilance team with outstanding safety queries, interacts with sponsor on site safety issues
• Reviews IND/SUSAR Safety Reports, updates/amendments to essential trial records, and annual IND reports with sponsor data (per sponsor request)
• Participates in management of trial-related committees (e.g., independent data monitoring committee (IDMC)/adjudication committees) as described in the corresponding trial-specific charter(s)
• Supports Pharmacovigilance, Medical Data Review and Data Management with reconciliation of safety and operational clinical trial databases
• Reviews clinical study reports (CSRs), including safety narratives and tables, figures, and listings (TFLs)
• Provides medical expertise on an as-needed basis in trials where medical monitoring is not a contract deliverable
• Prepares for and participates in trial audits, follows up on audit findings
• Participates in feasibility assessment of potential and ongoing trials in the country/region
• Participates in bid defense meetings and other interactions with clients
• Acts as a medical expert and provides therapeutic expertise to other PSI departments

Qualifications

• Medical Doctor degree required
• US Board Certification in psychiatry required
• Experience as a practicing psychiatrist (minimum of 10 years)
• Clinical Research experience preferred
• Proficiency with MS Office applications
• Communication, presentation and analytical skills
• Problem-solving, team and detail-oriented

For this position, PSI is not hiring individuals who require work visa sponsorship for employment now or in the future.

Additional Information

As part of PSI’s Medical Monitoring team, you will join our international group of medical professionals, build a career on the frontline of medical science and use your knowledge and expertise to help bring new medications to patients that need them.

Company Description

PSI is a leading Contract Research Organization with more than 30 years in the industry, offering a perfect balance between stability and innovation to both clients and employees.  We focus on delivering quality and on-time services across a variety of therapeutic indications.

Job Description

PSI Medical Monitors provide medical input to global clinical studies and advise the teams and business partners, while always focusing on patients’ safety and well-being.

Home-Based in United States

Responsibilities:

• Acts as the primary point of contact for all parties on all trial-specific medical and safety-related questions
• Provides input for responses to regulatory authorities and Institutional Review Boards (IRBs)/Independent Ethics Committees (IECs) on trial-specific medical and safety-related questions
• Monitors trial participant safety
• Participates in trial participant recruitment boost and retention activities
• Presents on medical matters at kick-off and investigator meetings
• Trains trial team in the therapeutic area and medical aspects of the protocol
• Develops and reviews trial-specific documents within the scope of medical monitoring
• Manages ongoing trial risks related to medical monitoring
• Performs ongoing medical review of the operational clinical trial database; provides support to Medical Reviewer(s) assigned to the trial
• Reviews protocol deviations
• Reviews RAE reports, writes and/or reviews SAE narratives, supports Pharmacovigilance team with outstanding safety queries, interacts with sponsor on site safety issues
• Reviews IND/SUSAR Safety Reports, updates/amendments to essential trial records, and annual IND reports with sponsor data (per sponsor request)
• Participates in management of trial-related committees (e.g., independent data monitoring committee (IDMC)/adjudication committees) as described in the corresponding trial-specific charter(s)
• Supports Pharmacovigilance, Medical Data Review and Data Management with reconciliation of safety and operational clinical trial databases
• Reviews clinical study reports (CSRs), including safety narratives and tables, figures, and listings (TFLs)
• Provides medical expertise on an as-needed basis in trials where medical monitoring is not a contract deliverable
• Prepares for and participates in trial audits, follows up on audit findings
• Participates in feasibility assessment of potential and ongoing trials in the country/region
• Participates in bid defense meetings and other interactions with clients
• Acts as a medical expert and provides therapeutic expertise to other PSI departments

Qualifications

• Medical Doctor degree required
• US Board Certification in Gastroenterology required
• Experience as a practicing Gastroenterology (minimum of 10 years)
• Clinical Research experience preferred
• Proficiency with MS Office applications
• Communication, presentation and analytical skills
• Problem-solving, team and detail-oriented

For this position, PSI is not hiring individuals who require work visa sponsorship for employment now or in the future.

Additional Information

As part of PSI’s Medical Monitoring team, you will join our international group of medical professionals, build a career on the frontline of medical science and use your knowledge and expertise to help bring new medications to patients that need them.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions.

Hi, we’re Oscar. We’re hiring a Physician Reviewer to join our Utilization Management team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: 8am - 5pm in your local time zone

Call rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: This is a remote position, open to candidates who reside in the United States. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $219,000- $ 286,902 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation, and annual performance bonuses.

Responsibilities:

• Provide medical reviews that meet Oscar’s stringent quality parameters.
• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
• Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
• Use correct templates for documenting decisions during case review.
• Meet the appropriate turn-around times for clinical reviews.
• Receive and review escalated reviews.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Board certification as an MD or DO
• Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
• 6+ years of clinical practice

Bonus points:

• Licensure in multiple Oscar states
• 1+ years of utilization review experience in a managed care plan (health care industry)
• BC in Cardiology, Radiation/Oncology, or Neurology
• Experience with care management within the health insurance industry.
• Willing and able to obtain additional state licensure as needed, with Oscar’s support

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraudhere.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care – an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Hi, we’re Oscar. We’re hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, SIU Clinical Investigator detects and audits aberrant billing patterns within claims and clinical documentation, using forensic clinical expertise to protect the integrity of healthcare spend. You will perform comprehensive pre-payment and post-payment reviews of medical records to ensure billed services align with established clinical guidelines, CMS regulations, and contractual obligations. Beyond individual claim accuracy, you will analyze provider behavior to identify schemes such as record cloning, upcoding, and unbundling that may be invisible to automated systems. As a clinical subject matter expert, you will act to translate audit findings into relevant education. You will facilitate professional discussions with colleagues and providers to correct billing behaviors and promote long-term compliance. You will partner with clinical and non-clinical investigators to build evidentiary files for potential recovery, legal action, or referrals to appropriate outside agencies.

You will report into the Investigations Manager, SIU.

Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.

If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role.  Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

The base pay for this role in the states of New Jersey and New York is: $75,348 - $98,894 per year. The base pay for this role in all other locations is: $67,813 - $89,004 per year.  You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities:

• Identify and conduct clinical audits into suspected FWA with high autonomy
• Document findings, to include formal reports, graphs, audit logs, and other supporting documentation.
• Metrics to align with unit goals.
• Participate in the development and presentation of FWA-related education for Oscar teams
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted Registered Nurse (RN) license
• 3+ years of direct patient care clinical experience. Case Management experience a bonus.
• 2+ years of experience in Medical Review, Utilization Management, or Clinical Documentation Improvement, featuring demonstrated expertise in the forensic application of complex clinical guidelines (e.g., MCG, CMS, and specialty-specific professional organizations) to multifaceted medical records.
• Experience conducting forensic medical audit with a focus on validating that clinical narrative supports the specificity and necessity of billed CPC, HCPCS, and ICD-10 codes.

Bonus points:

• Bachelor of Science in Nursing (BSN), Associate Degree in Nursing (ADN) with a Bachelor of Science in Health Administration, Clinical Informatics, or a related Medical Science field, or Associate Degree in Nursing (ADN) with 5+ years of specialized clinical audit experience.
• Experience working in health insurance with competency regarding claims processing, billing, reimbursement, or provider contracting.
• Experience delivering feedback or education to providers/physicians in a professional, non-confrontational, and persuasive manner.
• Identifying trends, for example “cloned documentation” or change in billing habits of a provider.
• Experience with HIPAA, data privacy, and/or data security processes
• Certified Case Manager (CCM), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraudhere.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care – an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

About Acadia Pharmaceuticals

Acadia is committed to turning scientific promise into meaningful innovation that makes the difference for underserved neurological and rare disease communities around the world. Our commercial portfolio includes the first and only FDA-approved treatments for Parkinson’s disease psychosis and Rett syndrome. We are developing the next wave of therapeutic advancements with a robust and diverse pipeline that includes mid- to late-stage programs in Alzheimer’s disease psychosis and Lewy body dementia psychosis, along with earlier-stage programs that address other underserved patient needs. At Acadia, we’re here to be their difference.

Location: Field-based position covering the West region, including Northern California, Oregon, and Washington. Candidates may reside anywhere within the assigned territory

Position Summary

The Senior Medical Science Liaison (MSL), Rare Disease - West serves as a key scientific resource within Medical Affairs, building trusted relationships with healthcare professionals, key opinion leaders (KOLs), researchers, and advocacy organizations. This field-based role is responsible for facilitating scientific exchange, advancing medical education, and providing strategic insights that support Acadia’s rare disease portfolio. The Senior MSL partners cross-functionally to deliver accurate, balanced scientific information while helping advance patient-focused research and therapeutic innovation. This field-based role is responsible for the West region, with coverage spanning Northern California, Oregon, and Washington, including major academic and community healthcare centers throughout the territory. Candidates may reside anywhere within the assigned region and must be able to travel up to 75%.

Primary Responsibilities

• Identifies and develops relationships with national and regional medical and scientific thought leaders, patient advocacy groups, and centers of excellence consistent with the strategy and objectives of Acadia’s Medical Affairs Development.
• Engages national and regional thought leaders to align interests, discuss research and medical information, and participate in scientific exchange and education about current and emerging therapies.
• Provides research trial site support and investigator-initiated research proposal cultivation and facilitation.
• Develops and maintains scientific, clinical and therapeutic expertise for Acadia’s portfolio.
• Cross-functionally collaborates, following all compliance guidelines, with regional field leadership partners including Regional Business Leaders (RBL) and Account  Business Managers (ABMs).
• Provides strategic field insights.
• Identifies disease concepts and compound characteristics that can be leveraged into product differentiation.
• Provide appropriate scientific, clinical, and educational support for internal and external clients.
• Represents the company at specific continuing educational events, programs, medical meetings and conventions.
• Supports Commercial operations by participating in Speaker and Sales Representative Training.
• Partners with the internal departments to ensure accurate delivery of medical and scientific information.
• Performs other duties as assigned.

Education/Experience/Skills

• Advanced degree required (MD, PharmD, or PhD) in a scientific discipline or related field
• Minimum 5 years of pharmaceutical or biotechnology industry experience
• Experience supporting rare diseases, epilepsy, neurology, or psychiatry therapeutic areas strongly preferred
• Previous Medical Science Liaison experience preferred
• Knowledge of pharmaceutical industry regulations, compliance requirements, and clinical research practices
• Ability to travel up to 75%, including overnight travel, with residence located within the assigned territory
• Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint

Physical Requirements

This role involves regular standing, walking, sitting, and the use of hands for handling or operating equipment. The employee may also need to reach, climb, balance, stoop, kneel, crouch, and maintain visual, verbal, and auditory communication in a standard office environment and while working independently from remote locations. The employee must occasionally lift and/or move up to 20 pounds.  This position requires the ability to travel independently overnight and/or work after hours as required by travel schedules or business needs.

In addition to a competitive base salary, this position is also eligible for discretionary bonus and equity awards based on factors such as individual and organizational performance. Actual amounts will vary depending on experience, performance, and location.

Salary Range

$181,300—$226,600 USD

What we offer US-based Employees:

• Competitive base, bonus, new hire and ongoing equity packages
• Medical, dental, and vision insurance
• Employer-paid life, disability, business travel and EAP coverage
• 401(k) Plan with a fully vested company match 1:1 up to 5%
• Employee Stock Purchase Plan with a 2-year purchase price lock-in
• 15+ vacation days
• 13 -15 paid holidays, including office closure between December 24th and January 1st
• 10 days of paid sick time
• Paid parental leave benefit
• Tuition assistance

EEO Statement (US-based Employees): Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications in the exact way they are described in job postings. We are committed to building a diverse, equitable, inclusive, and innovative company, and we are looking for the BEST candidate for the job. That candidate may be one who comes from a less traditional background or may meet the qualifications in a different way. We strongly encourage you to apply, especially if the reason you are the best candidate isn’t exactly what we describe here.

It is the policy of Acadia to provide equal employment opportunities to all employees and employment applicants without regard to considerations of race, including related to hairstyle, color, religion or religious creed, sexual orientation, gender, gender identity, gender expression, gender transition, country of origin, ancestry, citizenship, age, physical or mental disability, genetic information, legally-protected medical condition or information, marital status, domestic partner status, family care status, military caregiver status, veteran or military status (including reserve status, National Guard status, and military service or obligation), status as a victim of domestic violence, sexual assault or stalking, enrollment in a public assistance program, or any basis protected under federal, state or local law.

As an equal opportunity employer, Acadia is committed to a diverse workforce. If you are a qualified individual with a disability or a disabled veteran, you have the right to request a reasonable accommodation. Furthermore, you may request additional support if you are unable or limited in your ability to use or access Acadia’s career website due to your disability, along with any accommodations throughout the interview process. To request or inquire about your reasonable accommodation, please complete our Reasonable Accommodation Request Form or contact us at talentacquisition@acadia-pharm.com or 858-261-2923.

Please note that reasonable accommodations granted throughout the recruiting process are not guaranteed to be the same accommodations given if hired. A new request will need to be submitted for any ADA accommodations after starting employment.

California Applicants: Please see Additional Information for California Residents within our Privacy Policy.

Canadian Applicants: Please seeAdditional Information for Canadian Residents within our Privacy Policy.

Applicants in the European Economic Area, Switzerland, the United Kingdom, and Serbia: Please see Additional Information for Individuals in the European Economic Area, Switzerland, the United Kingdom, and Serbia within our Privacy Policy.

Notice to Search Firms/Third-Party Recruitment Agencies (Recruiters): The Talent Acquisition team manages the recruitment and employment process for Acadia Pharmaceuticals Inc. (“Acadia”). Acadia does not accept resumes from recruiters or search firms without an executed search agreement in place. Resumes sent to Acadia employees in the absence of an executed search agreement will not obligate Acadia in any way with respect to the future employment of those individuals or potential remuneration to any recruiter or search firm. Candidates should never be submitted directly to our hiring managers or employees.

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