Utilization management Jobs in Denver, CO

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Systems Administrator III, Health Systems - Epic, MyChart, Tapestry UM

Kaiser Permanente

•

Greenwood Village, Colorado, USA

Full-time

Job Summary: Configuration and support of our electronic medical record system Teir 3 support for our medical record system. Including incident support, ongoing maintenance, and investment projects. Our team supports KP HealthConnect, our electronic medical record. Specifically, the Web & Mobile (kp.org/MyChart) and Tapestry UM (Referrals) applications. In addition to the responsibilities listed below, this position is responsible for system build, testing, validation, and ongoing support of
Posted 5 days ago | Updated 4 hours ago

Systems Administrator IV, Health Systems - Epic, MyChart, Tapestry UM

Kaiser Permanente

•

Greenwood Village, Colorado, USA

Full-time

Job Summary: Our team supports KP HealthConnect, our electronic medical record. Specifically, the Web & Mobile (kp.org/MyChart), Tapestry UM (Referrals), and Population health (dealing with large cohorts of patients for common conditions like Diabetes or cancer care). Teir 3 support for our medical record system. Including incident support, ongoing maintenance, and investment. In addition to the responsibilities listed below, this position is responsible for system build, testing, validation, a
Posted 25 days ago | Updated 4 hours ago

Behavioral Health Clinical Reviewer- (LADC or BCBA Certification)

Javen Technologies, Inc

•

Remote

Contract

How Is This Role Important to Our Work? This job implements effective utilization management strategies including: review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qu
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Posted 1 day ago | Updated 23 hours ago

Care Manager - Health Plan

EnpowerTek

•

Remote

Full-time

Job Title: Care Manager - Health PlanLocation: Remote (CST hours)Schedule: Monday Friday, 8:00 5:00 pm CST Job Overview:This position focuses on comprehensive care management, including assessment, care planning, and coordination of services for members with moderate to high behavioral health needs. The Care Manager will oversee the delivery of person-centered care plans, monitor outcomes, and collaborate with internal and external resources to ensure quality, cost-effective services. Key Respon
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Posted 19 days ago

Epic Tapestry Membership Application Analyst II-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

•

Remote or Whittier, California, USA

Full-time

This position is 100% onsite Determination for the Epic Application Analyst (I, II or ), Tapestry Membership roles will be based on experience and qualifications. 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 wi
Posted 3 days ago | Updated 11 hours ago

Epic Application Analyst, Tapestry Core Administration II-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

•

Remote or Whittier, California, USA

Full-time

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
Posted 3 days ago | Updated 11 hours ago

Epic Tapestry Medical Management Application Analyst II-(Open to experienced remote in ID, NE, MO, OK, TX)

PIH Health

•

Remote or Whittier, California, USA

Full-time

Determination for the Epic Application Analyst (I, II or ), Tapestry Medical Management roles will be based on experience and qualifications. 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 app
Posted 3 days ago | Updated 11 hours ago

Senior Network Pricing Analyst - Hybrid in Las Vegas, NV

UnitedHealth Group

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Remote or Las Vegas, Nevada, USA

Full-time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Why work for the leading organization in health care to help improve the lives of millions? You'll fin
Posted 4 days ago | Updated 4 hours ago

Agile Product Owner Senior Advisor

Cigna

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Remote

Full-time

Role Summary: This role is for an Agile Product Owner within the Clinical IT Product Management team. This position will specifically be filling a Product Owner role within Agile/Scrum and the Scaled Agile Framework (SaFe) delivery process for primarily support of the UM/CM applications and any supporting or extension applications. This position will support up to 3 scrum teams. The Product Owner will be tasked with working with our business partners to understand and prioritize scope, engage i
Posted 18 days ago | Updated 4 hours ago

Senior Process Engineer (NA/ONPT) - Cigna Healthcare

Cigna

•

Remote or Bloomfield, Connecticut, USA

Full-time

WORK LOCATION: HYBRID / REMOTE The National Ancillary and Out of Network Protection Team (NA/ONPT) plays a significant role in Cigna's Enterprise Affordability strategy. Our team manages over 400 national contracts across US Commercial and US Government lines of business and roughly $9B in annual medical spend across National Ancillary, Direct Provider and Non-Par Cost Containment partnerships. The Program Management Senior Advisor is a key role in driving implementations, process improvements
Posted 7 days ago | Updated 4 hours ago

Data Analyst II Medical Economics

Centene Corporation

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Florida, USA

Full-time

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
Posted 12 days ago | Updated 4 hours ago

Data Analyst IV Medical Economics

Centene Corporation

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Missouri, USA

Full-time

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
Posted 10 days ago | Updated 4 hours ago

Data Analyst III Medical Economics

Centene Corporation

•

Missouri, USA

Full-time

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
Posted 33 days ago | Updated 4 hours ago

Registered Nurse | Field Case Manager | Hybrid | Essex County, NJ | Contract

Walker Healthforce

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Remote

Contract

Field Case Manager Registered Nurse | 2+ years | Onsite | New Jersey | Contract Walker Healthforce is seeking a Field Case Manager Registered Nurse with 2+ years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE:8/4/2025 RATE RANGE: $43-$53 HOURS/SCHEDULE: Will be in the field 5 days a week (8am-5pm/9am-5pm) seeing on average 3-4 members a day in their homes for assessment in Essex and Passaic Counties. A scheduler will be p
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Posted 4 days ago | Updated 4 days ago

Licensed Alcohol and Drug Counselor

Javen Technologies, Inc

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Remote

Contract

Licensed Alcohol and Drug Counselor Egan, MN 100 % Remote - Remote OK, but prefer to have MN License Contract : 6+ Months contract with possible extension Skills: LICSW, LPCC, LMFT, LP, LADC This requisition is for the Licensed Alcohol and Drug Counselor (LADC) How Is This Role Important to Our Work? This job implements effective utilization management strategies including: review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resou
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Posted 22 hours ago

Clinical Review Nurse - Concurrent Review

Pyramid Consulting, Inc.

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Remote

Contract

Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-78309 Pay Range: $33 - $39/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: Performs concurrent rev
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Posted 7 days ago

Medical Director

Pegasus Knowledge Solutions

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Remote

Full-time

SummaryThe Medical Director serves a clinical leader across all Client companies and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines. Key Responsibilities Clinical Oversight Provide medical guidance on complex or high-c
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Posted 16 hours ago

Medical Director -Remote- Fulltime/Direct Hire

Pegasus Knowledge Solutions

•

Remote

Full-time

Summary The Medical Director serves a clinical leader across all Client companies and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines. Key Responsibilities Clinical Oversight Provide medical guidance on complex or high-