utilization management Jobs in florida

1 - 20 of 129 Jobs

Prior Auth Nurse (RN)Job Title - Prior Auth Nurse (RN)

Pyramid Consulting, Inc.Company Name - Pyramid Consulting, Inc.

•

Remote

Contract

Immediate need for a talented Prior Auth Nurse (RN). This is a 03+months contract opportunity with long-term potential and is located in Olympia, WA (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:25-80708 Pay Range: $37 - $40/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 medical necessity and cli

Senior Medical Director Health Plan Analytics & Policy StrategyJob Title - Senior Medical Director Health Plan Analytics & Policy Strategy

Ztek ConsultingCompany Name - Ztek Consulting

•

Remote

Part-time

Job title: Senior Medical Director Health Plan Analytics & Policy Strategy role Location: Remote Department: Medical Management / Payment Integrity Reports to: Chief Clinical Officer or SVP of Medical Affairs Experience Level: 10+ years in a senior leadership role within health plan or payer environments Position Overview: We are seeking a strategic, data-driven Senior Medical Director with deep expertise in health plan operations, medical policy development, and cost management analytics. This

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

•

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

PIH HealthCompany Name - PIH Health

•

Remote or Whittier, California, USA

Full-time

Not currently working with 3rd party recruitment agencies. For immediate consideration email resume to or 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 w

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

•

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

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or Sedona, Arizona, USA

Full-time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health op

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or Phoenix, Arizona, USA

Full-time

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or San Francisco, California, USA

Full-time

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or Los Angeles, California, USA

Full-time

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or Albuquerque, New Mexico, USA

Full-time

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or Las Cruces, New Mexico, USA

Full-time

Medical Director - Clinical Review - CA, AZ or NM licensure - RemoteJob Title - Medical Director - Clinical Review - CA, AZ or NM licensure - Remote

OptumCompany Name - Optum

•

Remote or San Diego, California, USA

Full-time

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

Molina HealthcareCompany Name - Molina Healthcare

•

Remote or Augusta, Georgia, 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

PBM Communications SpecialistJob Title - PBM Communications Specialist

nTech SolutionsCompany Name - nTech Solutions

•

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

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

UnitedHealth GroupCompany Name - UnitedHealth Group

•

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

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

Centene CorporationCompany Name - Centene Corporation

•

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