Utilization management Jobs in Los Angeles, CA

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Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Walker Healthforce

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Remote

Contract

Utilization Management Appeals Nurse | 3 years | Remote | Contract Walker Healthforce is seeking a Utilization Management Appeals Nurse with 3 years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE: ASAP WORKER TYPE: W2 CORE REQUIREMENTS:Minimum of 3 years clinical experience.3 years experience in the health care delivery system/industry.Must have effective verbal and written communication skills and demonstrate the abilit
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Posted 1 day ago

Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Walker Healthforce

•

Remote

Contract

Utilization Management Appeals Nurse | 2 years experience | Remote | Contract Walker Healthforce is seeking a Utilization Management Appeals 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: 6/1/2025 HOURS/SCHEDULE: 8am-5pm EST Monday- Friday WORKER TYPE: W2 CORE REQUIREMENTS: Minimum of two (2) years clinical experience 3 - 5 years of experience with a background in either Utilization Management, Prior
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Posted 51 days ago | Updated 2 days ago

Care Manager - Behavioral Health

EnpowerTek

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Remote

Full-time

Job Title: Care Manager - Behavioral HealthLocation: California (must reside and be licensed in California)Schedule: Monday Friday, 8:00 5:00 pm Job Overview:We are seeking experienced Care Managers with a behavioral health focus to join a growing team supporting mental health and substance abuse programs. You will monitor inpatient and outpatient services, conduct concurrent reviews, and ensure medical necessity and quality of care for members. This role will also engage in crisis intervention,
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Posted 1 day ago

Care Manager - Health Plan

EnpowerTek

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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 1 day ago

CARE UMR Senior Data Analyst - Remote in New York or New Jersey

UnitedHealth Group

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Remote or New York, New York, 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. The CARE Sr. Data Analyst is responsible for supporting clinical report analysis and creation and deli
Posted 4 days ago | Updated 8 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 8 hours ago

Data Analyst III Healthcare Analytics

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 4 days ago | Updated 8 hours ago

Data Analyst II 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 26 days ago | Updated 8 hours ago

Clinical Data Governance/Informatics Lead - Cigna Healthcare - Hybrid

Cigna

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Remote or Bloomfield, Connecticut, USA

Full-time

Role Summary: Effective execution of good data governance principles and practices minimizes risk and ensures the data is available and fit for purpose. As part of The Cigna Group's Enterprise Clinical & Health Organization (ECHO), the Clinical Data Governance Lead is responsible for overseeing the integrity, quality, and governance of clinical data critical to ECHO operations, programs, and strategies. The ideal candidate should have a strong health care payer, clinical operations, and/or clini
Posted 3 days ago | Updated 8 hours ago

Program/Policy Analyst Sr (Medi-Cal Compliance)

CalOptima

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Orange, California, USA

Full-time

Program/Policy Analyst Sr (Medi-Cal Compliance) CalOptima CalOptima Health is seeking a highly motivated Program/Policy Analyst Sr (Medi-Cal Compliance) to join our team. The Program/Policy Analyst Sr (Medi-Cal Compliance) will coordinate and maintain CalOptima Health's relationship with regulatory agencies and ensure CalOptima Health and its First Tier, Downstream and Related Entities (FDRs) comply with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Sp