Utilization management jobs

Sr IT Director, Utilization Management & Complex Care Management

Pasadena, California

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Today

Upon start, selected candidate must reside in CA, CO, GA, HI, MD, OR, VA, WA, or District of Columbia. Please also note, this position may require reporting to the office up to 2-3 days per week. Technical Summary: The Sr Director will lead Utilization Management and Complex Care Management capabilities across the KP Enterprise under CDTS Acute, Outpatient, and Complex Care Product Portfolio. This role is critical in driving strategic transformation, operational excellence, and clinical integra

Full-time

USD 205,700.00 - 266,200.00 per year

Functional Architect - GuidingCare

Remote or Hybrid

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Today

Job TItle: Functional Architect - GuidingCare - 244891 Work Location: 100% Remote in the US Position Type: Consulting - 6+ Months Compensation Range: Negotiable, based on experience (W2 or 1099/LLC) ABOUT OUR CLIENT / ABOUT THIS ROLE Medix is currently seeking a Sr. Business Analyst / Functional Architect to help lead the implementation and configuration of HealthEdge (Altruista) Guiding Care with one of our Managed Care clients. This is a highly specialized role - we are seeking an experienc

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Contract

$80 - $125 per hour

Epic Application Analyst I, II, III, Tapestry Core Administration (Open to experienced remote in AZ, ID, TN, MO, OK, TX)

Remote or Whittier, California

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Today

PIH Health internal applicants or Altera employees (working at PIH Health as of May 2025), Epic certification in the required application/module must be obtained within 120 days of hire or transfer into the position. Failure to obtain certification within this timeframe may result in removal from the position; however, the employee will be eligible to apply for other internal openings for which they meet the minimum qualifications. External applicants must possess active Epic certification in t

Full-time

USD 102,481.00 - 169,104.00 per year

Medical Director - Prior Authorization Automation

Remote

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8d ago

Genzeon, an AI and automation company with deep engineering and data expertise, dedicated to serving the healthcare and retail industries. Our platform solutions including HIP One, CompliancePro Solutions, and Patient Engagement Solutions empower organizations to scale innovation and transform outcomes. Genzeon is a global community of innovators and problem-solvers, with a culture built on inclusion, flexibility, and purpose-driven work. With four global delivery centers, we support providers,

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Part-time

Depends on Experience

Managing Director- Local Network Solutions Lead- Cigna Healthcare

Remote or Bloomfield, Connecticut

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Today

Flexible Onsite Location: Willing to consider locations where The Cigna Group has an office presence. Position Summary: Cigna Healthcare seeks a visionary and results-oriented leader to serve as Managing Director- Local Network Solutions Lead. This role is responsible for shaping and executing product and network strategy for the U3K segment, with a focus on network design across Alternative Networks. This leader will also oversee go-to-market product commercialization and provider strategy & s

Full-time

Voip Engineer

Inver Grove Heights, Minnesota

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Today

Description Requisition Title Telecommunications Engineer: IV (Lead) Description Resume Must Haves: - Experience with Microsoft Teams Voice to support migration efforts to Microsoft Teams voice platform. - Experience with Contact Center as a Service (CCaaS) platforms such as Five9, NICE, Genesys or Cisco - The ability to work with the business to gather business requirements. - Not just understand the how, but also the why, when, and why not of telephony service delivery in support of business p

Full-time

USD 60.00 - 80.00 per hour

Data Analyst II Healthcare Analytics

Remote or Missouri

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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 55,100.00 - 99,000.00 per year

Data Analyst II Healthcare Analytics

Remote or Florida

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Today

Full-time

USD 55,100.00 - 99,000.00 per year

Aircraft Certification Engineer

Fort Worth, Texas

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Today

We're more than aviation experts, we're pioneers. We challenge what's possible. From breaking the sound barrier to advanced tiltrotor systems. Today, Bell is shaping the future of aviation through specialized engineering . And we want you. We are developing the future of Army Aviation with the Bell Future Long-Range Assault Aircraft (FLRAA) part of the US Army's Future Vertical Lift (FVL) modernization effort. We are also developing the Bell 525 Relentless and Bell's High-Speed Vertical Take-Of

Full-time

Data Analyst III Healthcare Analytics

Remote or Missouri

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Today

Full-time

USD 68,700.00 - 123,700.00 per year

Technical Analyst

Houston, Texas

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Today

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have

Full-time

USD 55,600.00 - 79,400.00 per year

Technical Analyst

Dallas, Texas

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Today

Full-time

USD 55,600.00 - 79,400.00 per year

Technical Analyst

Austin, Texas

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Today

Full-time

USD 55,600.00 - 79,400.00 per year

Data Analyst II Medical Economics

Remote or Missouri

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Today

Full-time

USD 55,100.00 - 99,000.00 per year

Data Engineer // Snowflake + dbt focus - FULLY REMOTE

Remote or Missouri

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Today

Job#: 2083315 Job Description: Apex Systems is hiring a Data Engineer for a major Healthcare company. 4+ month contract FULLY REMOTE anywhere in the United States, CST preferred. You must be authorized to work in the United States without sponsorship. About the role: This role will join the Clinical Analytics Engineering team to play a key part in standardizing and consolidating clinical data across internal and vendor platforms into a single model for the enterprise. The clinical data in scope

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Full-time

Data Analyst IV Medical Economics

Remote or Missouri

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Today

Full-time

USD 86,000.00 - 154,700.00 per year

NetworX Configuration Analyst

Remote

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Today

NetworX Configuration Analyst SME Remote Job. Job requirements: Experience with Plan-Product configuration, Pricing configuration, and workflow. A vast working knowledge in Facets and has the ability to help and educate other team members and support operations to identify opportunities with configuration and best practices to support requirements from a Facets point of view. Configuration experience in commercial lines of business as well as government programs (Medicaid - Medicare). SME for

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Third Party, Contract

Business Analyst with FHIR/EMR

Parsippany-Troy Hills, New Jersey

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17d ago

Key Experience Areas: FHIR Standards & API Integration:Proven experience working with HL7 FHIR specifications, including resource modeling, API design, and implementation for clinical data exchange.Lead requirements gathering and gap analysis for FHIR-based APIs to support patient data exchange across systems.Collaborated with development teams to define resource mappings and ensure compliance with HL7 standards.Participated in testing and validating FHIR endpoints for clinical and administrati

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Contract

Depends on Experience

Product Owner- Pharmacy/PBM

Remote

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4d ago

We are seeking a highly motivated Product Owner with strong experience in pharmacy, PBM, or specialty pharmacy products. The ideal candidate will work closely with stakeholders, business teams, and engineering to define, prioritize, and deliver innovative healthcare technology solutions that enhance patient outcomes, optimize pharmacy workflows, and support value-based care initiatives. Key Responsibilities Act as the primary liaison between business stakeholders, pharmacy operations, PBM clien

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Contract

Depends on Experience

.NET Developer

Torrance, California

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Today

Description We are looking for a strong .NET Applications Developer in Southern California. This is a long-term contract opportunity and will need someone who can be onsite 4 days per week. Job Details Analyze and prioritize enhancement requests: Review backlog items and refine requirements with stakeholders. Perform code reviews and testing: Validate .NET and SQL changes in development or QA environments. Update and maintain documentation: Revise system design documents, workflows, and technic

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Contract

USD 55.00 - 59.00 per hour

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Utilization management jobs