Utilization management Jobs in San Diego, CA

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PBM Communications Specialist

nTech Solutions

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Remote

Contract

Must-Have: Must have a Laptop/computer with internet to work from home. Comfortable providing a Photo ID Copy Terms of Employment: W2 Contract-to-Hire, 12 Months This position is remote. Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas. Overview: We are seeking a PBM Communications Specialist for a leading managed care organization to ensure all pharmacy-related communications are accurate
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Posted 51 days ago | Updated 1 day 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 14 days ago | Updated 1 hour 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 41 days ago | Updated 1 hour ago

Data Analyst III 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 43 days ago | Updated 1 hour 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 14 days ago | Updated 14 days ago

RxCLAIM SME(Business / Systems Analysis)

Helishores Inc

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Remote

Contract, Third Party

Role: RxCLAIM SME Location: Remote Required: Minimum of 8+ years' experience in PBM operations, with direct involvement in plan design and configuration. Deep expertise in RxCLAIM or comparable adjudication systems. Familiarity with NCPDP standards and formulary management. Strong understanding of Commercial & Medicare benefit structures involving Formularies/Drug lists, Pharmacy Networks and Pricing (Client/Pharmacy) Excellent analytical and documentation skills, with ability to translate busin
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Posted 18 hours ago

RxCLAIM SME

Data Wave Technologies Inc

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US

Contract

Job Title: RxCLAIM SME Location: Remote Duration: Long term Tax Term: W2 Key Technology: RxClaim, PBM Job Responsibilities: Act as a subject matter expert in pharmacy benefit plan design across RxCLAIM or similar adjudication platforms. Create Current state flows for each functional component and their interactions with benefit build process within RxCLAIM and downstream applications. Develop and document plan designs including tier structure, copays, accumulators, exclusions, step therapy,
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Posted 1 day ago | Updated 1 day 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