Utilization Management jobs in New York, NY

HARP Care Manager (with up to $10,000 additional field differential)

New York, New York

•

Today

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. POSITION OVERVIEW The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his/her assigned Health Home, primary caregiver, the primary and attending physicians, and various Be

Full-time

Salesforce Developer with System Integration and Health cloud

Remote

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2d ago

We're seeking a Salesforce Developer with strong experience in system integrations and Health Cloud configuration. You'll design and build secure integrations to EHRs and healthcare platforms, configure Health Cloud capabilities (Care Programs, Patient/Provider management, Assessments), and develop scalable components using Apex/LWC/Flows. What You'll Do Design, build, and maintain integrations with Health Cloud and thirdparty systems. Ensure security & compliance (HIPAA, PHI/PII), OAuth 2.0/JWT

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Contract

Depends on Experience

Aetna IT Medicaid Senior Product Manager

Remote or Downers Grove, Illinois

•

Today

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 CVS Health is embarking on a bold digi

Full-time

USD 118,450.00 - 260,590.00 per year

Epic Tapestry UM Analyst - 100% Remote

Remote or Eden Prairie, Minnesota

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Today

Genesis10 is currently seeking a Tapestry UM Analyst for a 3-month contract role with our client. This role will be 100% remote. Compensation: $80.00 - 90.00 per hour, W2, depending on skill and experience level. Summary: We are seeking an experienced Epic Tapestry Utilization Management (UM) Analyst to design, build, optimize, and support UM workflows focused on prior authorizations and referrals. This role partners closely with UM leadership, clinical reviewers, provider relations, care manag

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Full-time

USD 80.00 - 90.00 per hour

Data Analyst II Healthcare Analytics

Remote or Florida

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Today

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of v

Full-time

USD 56,200.00 - 101,000.00 per year

Data Analyst II Healthcare Analytics

Remote or Michigan

•

Today

Full-time

USD 56,200.00 - 101,000.00 per year

Sr Aerospace Engineer - Aircraft Certification

Remote or Plano, Texas

•

Today

The ISR (Intelligence, Surveillance & Reconnaissance), Aviation, and Security (IAS) business area is a leader in ISR and aviation, it is a leading prime manned and unmanned aircraft systems integrator for innovative, high-performance ISR and aviation systems. Its end-to-end Command, Control, Computers, Communications and Intelligence, Surveillance & Reconnaissance (C4ISR) capabilities encompass design, integration, test, certification, ground/flight training and complete logistics support. IAS t

Full-time

Epic Systems Analyst II (UM/Referrals exp req)- Kelsey Seybold Clinic

Remote or Pearland, Texas

•

Today

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher pat

Full-time

USD 72,800.00 - 130,000.00 per year

Senior Data Scientist - Remote, W2

Remote

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6d ago

Senior Data ScientistRemote Seeking- senior/manager level data science candidatesThis P5 Decision Scientist will be a part of the End-to-End team. The project focuses on improving the end-to-end admission and approval process within utilization management. When patients need admission, multiple insurance approvals are required, some of which can be automated while others need human review. The goal is to streamline this pipeline, ensuring that approvals happen quickly, efficiently, and accuratel

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Contract

$70+

Authorization Specialist I

Remote

•

13d ago

Immediate need for a talented Authorization Specialist I. This is a 09 Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:26-01674 Pay Range: $20 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: This request is for support in the a

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Contract

20 - 21

Hiring for Sr. Medical Reviewer || 100% Remote (Looking someone from IL OR TX)

Remote

•

6d ago

Role: Sr. Medical Reviewer Location: (100% Remote) Duration: 12+ months (Remote) Skills & Experience: Fully Remote, but MUST reside in either TX or IL Required hours: Monday through Friday, 8a-6p intermittent occasional coverage of weekend shifts MUST have an ACTIVE Medical/Doctor License to practice in the state they reside MUST have 10+ years clinical experience with managed care and utilization management Evaluates clinical service requests made by an organization's members and providers. Use

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Contract

$50 - $60

Salesforce Developer Health Cloud / Field service Lightning (FSL/FSM)

Remote

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2d ago

Position : Salesforce Developer Health Cloud / Field service Lightning (FSL/FSM) 100% Remote About the Role We're seeking a Salesforce Developer with strong experience in system integrations and Health Cloud configuration. You'll design and build secure integrations to EHRs and healthcare platforms, configure Health Cloud capabilities (Care Programs, Patient/Provider management, Assessments), and develop scalable components using Apex/LWC/Flows. What You'll Do Design, build, and maintain integr

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Contract

Depends on Experience

Cognos Developer - W2 ONLY

Remote

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4d ago

This is a W2 opportunity, and candidates who don't require visa sponsorship are allowed to apply for this role Title: BI Programmer - Cognos (Healthcare Business Intelligence) Terms of Employment W2 Contract, 12 Months This is a Remote Opportunity Overview Our Client is looking for a Senior Health Intelligence Programmer who is responsible for developing, enhancing, and maintaining the core data processing platforms of the company, driving business solutions by querying existing databases to cre

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Contract

Depends on Experience

HARP Care Manager

New York, New York

•

Today

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + HospitalsMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, in

Full-time

Data Analyst III Medical Economics

Remote or Missouri

•

Today

Full-time

USD 70,100.00 - 126,200.00 per year

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Utilization Management jobs in New York, NY, USA