Utilization management jobs

Applied Behavior Analysis / ABA (Utilization Management)

Remote

•

Today

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

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Contract

Depends on Experience

Epic Tapestry Utilization Management

Philadelphia, Pennsylvania

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Today

Epic Tapestry Utilization Management Consultant We are seeking an experienced Epic Tapestry Utilization Management Consultant for a three-month contract engagement supporting the build and implementation of Appeals and Grievances workflows. ResponsibilitiesDesign, build, configure, and test Epic Tapestry functionality supporting Appeals and GrievancesTranslate operational and regulatory requirements into effective Epic workflows and system configurationPartner with utilization management, clinic

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Full-time

Utilization Management Specialist - Behavioral Health

Remote

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28d ago

Hi, Hope youre doing well!! Please find the requirement below. If you find yourself comfortable with the requirement please reply back with your updated resume or call me back at Position:Utilization Management Specialist - Behavioral Health Location:Remote(Must reside in the DMV area Maryland, Virginia, or Washington, DC) Duration: 6+ Months Visa: Client won't be able to sponsor any visa LinkedIN ID We are seeking experiencedBoard Certified Behavior Analysts (BCBAs)to join our cl

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Contract, Third Party

Depends on Experience

Utilization Management Program Manager-RN

Corvallis, Oregon

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Today

Summary \t \t \tSamaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO

Full-time

Senior Data Scientist - Utilization Management

Wellesley, Massachusetts

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Today

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Position Summary At CVS/Aetna, we're pioneering a total

Full-time

USD 101,970.00 - 222,480.00 per year

Product Manager Medical Management Platform

Hybrid in Eagan, Minnesota

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Yesterday

Job Title: Product Manager Medical Management Platform Duration: Long-term Location: Eagan, MN Job Description: Product Manager Medical Management Platform Led the transformation of a next-generation Medical Management platform integrating Utilization Management (UM), Care Management (CM), and Member Appeals to improve operational efficiency and member outcomes. Key Responsibilities Led business process transformation initiatives and future-state workflow design across UM, CM, and Appeals.Direct

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Contract

Depends on Experience

Project Manager with Medicare/Medicaid and Pharmacy Benefits Management expertise

Remote

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2d ago

We are seeking to hire several Project Managers with expertise in Medicare/Medicaid system implementation projects, including specific expertise in PBM (Pharmacy Benefits Management), to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of health

Easy Apply

Full-time

Depends on Experience

Product Manager Medical Management Platform

Hybrid in Eagan, Minnesota

•

2d ago

Easy Apply

Contract

Depends on Experience

PMO Project Manager with Medicare / Medicaid system experience and RAID expertise

Remote

•

Yesterday

We are seeking to hire several PMO Project Managers with expertise in Healthcare / Medicare/Medicaid system implementation projects, to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid claims systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance,

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Full-time

Depends on Experience

Engineering Test Pilot, Experimental Flight Test

Wichita, Kansas

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20d ago

Posting Start Date: 4/21/26 Requisition ID: 12883 Wichita, KS, USA, 67209-2924 When applicable, Bombardier promotes flexible and hybrid work policies. Why join us? At Bombardier, we design, build and maintain the world's peak-performing aircraft for the world's most discerning people and businesses, governments and militaries. We have been successful in setting the highest standards by putting our people at the heart of it all, and defining excellence, together. Working at Bombardier means o

Full-time

Architectural Associate

Columbia, Missouri

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Today

Hiring Department Planning, Design & Construction Job Description Provides skilled architectural design services to meet client requests/needs.Possesses both a broad and deep understanding of the job.Understands how own and related teams coordinate their efforts and resources to achieve objectives and goals.Provides solutions to problems in situations that are atypical or occur infrequently.Uses discretion to modify work practices and processes to achieve results or improve efficiency.Confers

Full-time

USD 25.96 - 28.13 per hour

Senior Healthcare Integration Engineer – FHIR / Da Vinci

Remote

•

Yesterday

Role: Senior Healthcare Integration Engineer FHIR / Da Vinci Location: Remote Job Description * Design, develop, and implement Da Vinci FHIR solutions supporting CMS-0057-F compliance, including Coverage Requirements Discovery (CRD), Documentation Templates & Rules (DTR), and Prior Authorization Support (PAS) APIs. * Build and deploy production-ready APIs leveraging FHIR R4 standards and best practices for healthcare interoperability. * Design and implement integrations between payer systems, u

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Contract, Third Party

Depends on Experience

Nurse RN 3

Remote

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16d ago

Day to Day ResponsibilitiesThe Clinical Quality Review (CQR) team investigates and reviews potential quality of care issue (PQI) allegations or concerns arising from member grievances and internal referrals. PQI reviews may confirm a quality problem that resulted in or had the potential for harm to the member and can lead to identification of provider opportunities for improvement related to practice patterns that are outside the framework of accepted standards. The Clinical Quality Reviewer wil

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Contract, Third Party

$45 - $48

Mechanical Systems Engineer-Sr./ Specialist/ Specialist-Sr-Wheels, Tires, Brakes UM

Wichita, Kansas

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Today

JOB SUMMARY: Responsible for ensuring the proposed Landing Gear and Wheels, Tires, and Brakes system design is certifiable, coordinating with the ODA/FAA, resolution of certification issues, witnessing certification testing, and finding compliance. JOB RESPONSIBILITIES: Responsible for successful integration and certification of vendor equipment into Textron Aviation aircraft Assists in preparation, review, and approval of Textron Aviation certification plans, supplier test plans, reports, engin

Full-time

Healthcare Data Analyst

Overland Park, Kansas

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Today

*This is an onsite position. The successful candidate must reside in the Kansas City metro area. This job is responsible for performing statistical modeling and data analysis to develop metrics, reports, and visualizations that identify trends and patterns of business importance. The scope of this job includes collaborating with stakeholders to understand data needs, and presenting data to influence decision-making. We invite you to apply today and join us in shaping the future of healthcare!

Full-time

Structural Analysis Engineer - Systems 4

North Charleston, South Carolina

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Today

This posting is for a contract assignment and is not a full-time employment offer with Boeing. Candidates selected for roles will be employed as contract workers through a Boeing approved 3rd party for the duration of the specified project. Work statement is a non-managerial role, non-leadership role. Structural Analysis Engineer - Systems Stress Leads development, integration and documentation of structural requirements to establish the system design. Coordinates with other engineering groups

Full-time

Electrical Engineer

Columbia, Missouri

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Today

Hiring Department Facility Operations Job Description Position Summary The Electrical Engineer provides professional engineering expertise to support the safe, reliable, and code-compliant operation of building electrical systems across a large higher-education campus. Reporting within the Engineering Services group of Facilities Operations, this position serves as a key technical resource for maintenance staff, capital project teams, and campus stakeholders. The role focuses on building-leve

Full-time

USD 115,000.00 - 130,000.00 per year

Electrical Engineer II

Columbia, Missouri

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Today

Hiring Department Planning, Design & Construction Job Description At Planning, Design, and Construction, we are passionate about shaping the University of Missouri (MU) Columbia campus' future by creating innovative, high-quality spaces that inspire and support the university's mission. We lead every phase of design and construction, from concept to completion, ensuring projects are delivered on time, within budget, and to the highest standards. Whether it is new buildings, renovations, or in

Full-time

USD 95,000.00 - 98,000.00 per year

Senior Software Engineer - AI Systems

New York, New York

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Today

Senior Software Engineer (Agentic AI / Healthcare) Location: New York, NY (Manhattan), Hybrid (3 days onsite) Compensation: $150,000-$250,000 base + equity Contact / Apply: Ryan Johnston - About Our Client Our client is a venture-backed healthcare technology company based in New York and Toronto, building agentic AI solutions that reimagine how medications are prescribed, verified, and supported across the pharmacy ecosystem. Backed by $4M in funding and trusted by multiple Fortune 50 healthca

Full-time

USD 150,000.00 - 250,000.00 per year

Senior EMC Engineer - Aviation

Olathe, Kansas

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Today

Overview We are seeking a full-time Senior EMC Engineer - Aviation at Garmin's U.S. headquarters in the Greater Kansas City area. In this role, you will be responsible for leading the Electromagnetic Compatibility (EMC) Certification and/or testing for complex products and/or integrated systems and provides technical leadership for EMC project planning and programs. The Aviation team is responsible for demonstrating compliance with High Intensity Radiated Fields (HIRF) and Lightning for TSO (Te

Full-time

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Utilization management jobs