Top 79091 Institute Jobs

Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)
TMF Health Quality Institute —Remote
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- Disability insurance
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Registered Nurse Cardiovascular ICU
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Part Time Nursing Supervisor RN *No Weekends*
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Clinical Adjudication Manager (Weekday Evening Shift + Flexible Scheduling (Part Time or Full Time) (Part C)

TMF Health Quality Institute -
Remote

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Job Details

Full-time

Benefits

License reimbursement
AD&D insurance
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Vision insurance
Life insurance

Qualifications

Appeals
Respiratory therapy
Nursing
Project development phase management
Respiratory Therapy
Medicare
Corporate training
Project communication management
Occupational therapy
Supervising experience
Case appeal in utilization management
Team management
Utilization management
Project management experience in healthcare
Healthcare team management
Meeting facilitation
Presentation preparation
Instructional materials development
1 year
Senior level
Associate's degree
Insurance claims appeal handling
Project stakeholder communication
Stakeholder relationship building
Educational content composition projects
Physical therapy

Full Job Description

Category: Program Management

Requisition Number: CLINI001409

Posting Details

- Posted: June 10, 2026
Full-Time
Remote
Locations

Remote, Anywhere USA

Job Details

Description

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

*This position is located Remote United States*

This position is weekday evening shift (Part Time or Full Time) and has flexible scheduling

Position Purpose:

Manages project activities and participates in the development and monitoring of all related tasks. Manages medical and non-medical appeals decisions.

Essential Responsibilities:

Plans and manages project activities to meet contract deliverables.
Plans, manages, and develops a standardized approach for dissemination and communication of project information.
Plans, manages, and develops presentations or instructional materials related to area of responsibility.
Plans, prepares, and facilitates regular team meetings.
Manages, trains, and evaluates project work activities and personnel.
Manages the administrative processing of appeals/disputes and the coordination of workflow among internal staff and subcontractors.
Manages, establishes, and maintains professional and effective working relationships with external business partners and internal staff.

Minimum Qualifications

Education

Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
- Additional clinical or medical administration experience may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience

Five (5) years conducting or overseeing Medicare appeals, medical review, or utilization management of Medicare claims.
Three (3) years management or supervisory

Healthcare Professional with one (1) year demonstrated experience writing, making, or overseeing Medicare related medical necessity decisions
Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Conducting or overseeing Medicare Part C related appeals activities, preferred

Benefits

C2C offers an excellent benefits package, including:

Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
Section 125 plan
401K
Competitive salary
License/credentials reimbursement
Tuition Reimbursement

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Apply Now

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