Utilization management Jobs in San Jose, CA

1 - 20 of 125 Jobs

Behavioral Health Clinical Reviewer- (LADC or BCBA Certification)Job Title - Behavioral Health Clinical Reviewer- (LADC or BCBA Certification)

Javen Technologies, IncCompany Name - Javen Technologies, Inc

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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

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

PIH HealthCompany Name - PIH Health

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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

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

PIH HealthCompany Name - PIH Health

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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

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

PIH HealthCompany Name - PIH Health

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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

Care Manager - Health PlanJob Title - Care Manager - Health Plan

EnpowerTekCompany Name - 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

Senior Network Pricing Analyst - Hybrid in Las Vegas, NVJob Title - Senior Network Pricing Analyst - Hybrid in Las Vegas, NV

UnitedHealth GroupCompany Name - 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

Agile Product Owner Senior AdvisorJob Title - Agile Product Owner Senior Advisor

CignaCompany Name - 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

Senior Process Engineer (NA/ONPT) - Cigna HealthcareJob Title - Senior Process Engineer (NA/ONPT) - Cigna Healthcare

CignaCompany Name - Cigna

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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

Data Analyst II Medical EconomicsJob Title - Data Analyst II Medical Economics

Centene CorporationCompany Name - 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

Data Analyst IV Medical EconomicsJob Title - Data Analyst IV Medical Economics

Centene CorporationCompany Name - Centene Corporation

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Missouri, USA

Full-time

Data Analyst II Medical EconomicsJob Title - Data Analyst II Medical Economics

Centene CorporationCompany Name - Centene Corporation

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Michigan, USA

Full-time

Senior Analyst, Medical Economics - REMOTEJob Title - Senior Analyst, Medical Economics - REMOTE

Molina HealthcareCompany Name - Molina Healthcare

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Remote or Caldwell, Idaho, USA

Full-time

JOB DESCRIPTION Job Summary The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to