Clinical Policy Jobs

Experienced correctional RN needed to lead clinical operations, coach site teams, and ensure accreditation and compliance across Wellpath facilities.

Work as a clinically focused RN on Humata Health’s payer operations team to digitize policies and validate AI-driven prior authorization workflows.

Lead Orchard’s US regulatory science strategy as Executive Director, advising cross-functional teams and managing FDA interactions to advance the company’s pipeline.

Lead clinical review and care coordination for medically complex MassHealth members by supervising eligibility/authorization processes, interpreting regulations, and partnering with providers and state agencies.

Presbyterian Homes & Services seeks an LPN or RN to lead infection prevention and control efforts at its Bloomington senior living community, providing education, surveillance, and policy implementation.

AHRC New York City is hiring a Nursing Coordinator to lead and manage residential nursing services, ensuring clinical oversight, compliance, and staff development for individuals served under OPWDD.

Humata Health is hiring an RN with utilization management experience to help digitize payer policies, validate AI-driven prior authorization workflows, and coordinate cross-functional projects.

A licensed RN with clinical operations and QA experience will manage clinical quality, conduct chart reviews and resolve patient escalations for Vida's virtual obesity care programs.

Humana seeks a licensed Texas DDS/DMD with clinical and utilization review experience to serve as Dental Director, providing clinical oversight of claims, appeals, policy development, and quality initiatives for its Texas member population.

Experienced BSN-prepared RN to lead clinical practice initiatives, provide EPIC ambulatory education, and advance clinical quality and staff competency across Northwestern Medicine practices.

Clinical Pharmacist (Utilization Management) to support PBM clinical operations by reviewing utilization requests, creating policy, and coordinating with prescribers and internal teams to drive safe, cost-effective medication access.

Lead statewide correctional health programs as an experienced registered nurse manager, supervising clinical teams and ensuring care meets ODOC policies and Commission on Correctional Health Care standards.