utilization management jobs in montana

Utilization Management Specialist (Remote)

Remote or Oakland, California

•

Today

Software Guidance & Assistance, Inc., (SGA), is searching for a Utilization Management Specialist for a Contract assignment with one of our premier Healthcare clients in Oakland, CA . Responsibilities : The Utilization Management Specialist (UMS) will play a pivotal role in supporting the Utilization Management (UM) team across all three AHS campuses. This multifaceted position will focus on both clinical and administrative functions within the UM department, ensuring seamless operations

Contract

USD 20.00 - 27.00 per hour

Data Scientist - Utilization Management

Remote or Wellesley, Massachusetts

•

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: If you're eager to make a real impact

Full-time

USD 64,890.00 per year

Senior Data Scientist - Utilization Management

Remote or Wellesley, Massachusetts

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Today

Full-time

USD 101,970.00 - 222,480.00 per year

Epic Tapestry

Remote

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2d ago

DTS is looking for Epic Tapestry for our direct client position Role description: Provide specialized expertise in Epic systems to support the implementation and optimization of healthcare solutions. Configure and customize Epic modules according to project requirements. Troubleshoot and resolve issues related to Epic systems. Conduct system testing and validation to ensure functionality and performance. Provide training and support to end-users on Epic applications. Document system configurati

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Contract, Third Party

DOE

MCNCE VISTA- Veteran & Military Student Success Data Analyst

Montana

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Today

MCNCE VISTA- Veteran & Military Student Success Data Analyst The Military and Veteran's Service Office (MVSO) located on the University of Montana campus in Missoula supports student veterans and their families. UM is home to nearly 1000 military-affiliated students, and UM is the nation's 3rd highest percent of veterans on campus per capita in the nation. The goal of the VISTA project is to help student veterans and their families break the cycle of poverty and low-income occupations through i

Full-time

Integration Developer

Remote or Pinellas Park, Florida

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Today

RESPONSIBILITIES: Kforce has a client in Pinellas Park, FL that is seeking an Integration Specialist to lead and support healthcare data integrations between hospital EMR systems and our internal systems. These integrations power our physician advisory services, enabling clinical, utilization management, and revenue cycle insights that directly impact hospital financial outcomes. This role is ideal for someone who has worked hands-on with Epic and Cerner, understands HL7-based and FHIR data exch

Contract, Third Party

$70 - $80 hourly

Manager, Epic Payer Platform and Cloud Infrastructure (AWS)

Remote or St. Louis, Missouri

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17d ago

Systems Analysis Manager - Epic Payer Platform (AWS) We're building the future of connected healthcare-and we're looking for a seasoned application development leader to help lead the way. In this role, you'll shape how payer and provider systems work together, powering seamless, secure, and scalable experiences through Epic and AWS. You'll bring deep expertise, curiosity, and care-balancing high standards with compassion for the people and teams you support. Responsibilities (Outcomes & Strate

Full-time

Facets Benefit Configuration Consultant

Remote or Georgia

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Today

Stellar Consulting Solutions is a boutique business & technology consulting company headquartered in Atlanta, GA. We deliver high quality, agile, and experienced workforce for niche technology projects of any scale. We help forward thinking clients to solve specific problems by understanding their needs and align talent that can move fluidly to match skill supply and demand on a real-time basis. Stellar Consulting has a unique combination of technical and digital skills to recruit, engage, and

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Third Party, Contract

$70

Technical Product Manager

Remote or Hybrid

•

Today

Must have: inpatient EMRs, FHIR integrations, AI, or Utilization management experience ? Partner with the Solution Product Manager responsible for defining the product roadmap. ? Translate product capabilities into clearly defined features and user stories. ? Develop detailed development requirements and testing criteria, and oversee the testing process. ? Work within a Kanban delivery model. ? Support the technology behind InterQual, a solution used by both payers and hospitals to evaluate and

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Contract

$60-$65

BUSINESS ANALYST

Remote or Hybrid in New York, New York

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3d ago

Business Analyst Healthcare (1 2 Years Experience)Company: AaraTech Inc About the Role: AaraTech Inc is seeking a motivated and detail-oriented Business Analyst Healthcare to support healthcare and health plan operations through data analysis, reporting, and documentation. This role is ideal for early-career professionals looking to build a career in healthcare analytics within a regulated environment. The Business Analyst will collaborate with cross-functional teams to support reporting initiat

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Contract

$60,000 - $70,000

Clinical Delegation Oversight Manager - REMOTE

Remote

•

Today

JOB DESCRIPTION Job Summary Provides advanced clinical and operational expertise to ensure delegated clinical functions - such as Utilization Management (UM), Care Management (CM), Behavior Health (BH), Disease Management (DM), and Quality programs - meet expected financial and clinical outcomes, organizational contractual, regulatory, and accreditation (NCQA, CMS, State) requirements. Leads end-to-end oversight activities, including performance monitoring, audits, corrective action management,

Full-time

USD 65,791.66 - 142,548.59 per year

Data Analyst II Healthcare Analytics

Remote or Missouri

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Today

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employmen

Full-time

USD 56,200.00 - 101,000.00 per year

Data Analyst IV Healthcare Analytics, Medical Economics

Remote or Michigan

•

Today

Full-time

USD 87,700.00 - 157,800.00 per year

Director, Data Management (EIM / Health Plan Analytics / AI & ML) - REMOTE

Remote or Long Beach, California

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Today

Job Description Director, Data Management (EIM) Job Summary The Director, Data Management is a senior leadership role within Molina Healthcare responsible for enterprise data management strategy, delivery, and modernization across core health plan domains. This role leads the design, integration, and operation of data platforms that support Medicaid, Medicare, Marketplace, and other payer lines of business, with a strong emphasis on Databricks-based lakehouse architecture, AI-enabled data man

Full-time

Sr. Full Stack Software Engineer

Remote or Kentucky

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Today

Become a part of our caring community Humana is seeking a Full Stack Software Engineer - Information Marketplace team, responsible for building and enhancing the enterprise platform used to discover, understand, and access data across Humana's information ecosystem. The Senior Full Stack Engineer performs software engineering activities in all layers of the stack, from setting up the database to programming in the back-end and the appearance at the front-end. The Senior Full Stack Engineer work

Full-time

USD 106,900.00 - 147,000.00 per year

Epic Payer, Director

Remote

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30+d ago

Job Title: Epic Payer Director / Managing Director Location: Remote (U.S.) Travel: 1025% based on client needs Job Type: Full-Time Compensation: Director: $175K$225K base + 15% bonus Managing Director: $215K$275K base + 18% bonus Equity potential for senior-level hire Epic Payer Director / Managing Director (Remote) A growing healthcare consulting firm is expanding its Epic Payer practice and hiring a senior leader to oversee complex payer-platform engagements. This role provides executive

Easy Apply

Full-time

$275000

Product Development Coordinator/Manager

Remote

•

Yesterday

Hiring a Product Development Manager with experiencein the Health Plan, PBM, or Medicare Advantage space; experience coordinating offshore development teams; strong Agile/Scrum and SDLC knowledge 100% remote in US only What Youll Do 1) Product Strategy & Roadmap Own the product strategy forclaims intake, validation, adjudication, pricing, payment, remittance, audit, and related integrations (EHR, Enrollment, UM, Risk, Quality/NCQA, Coding Scrubber). Define and maintain aquarterly roadmapaligne

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Full-time

$150000

Epic Tapestry Application Developer - Tapestry UM

Remote

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Today

Job Title: Epic Tapestry Application Developer - Tapestry UM Location: Remote Duration: Temp - 12 months (Possible Extension) Pay Range: $60/hr $66.7/hr (W2) Job ID: 372017 About BCforward BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North Ameri

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Contract

$60 - $66.70 per hour

Medicare Appeals Professional with Licensed nurse

Remote

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Today

Responsibilities: Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, andimpartial and supports the determination made, and documents review.Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation,rulings, and policy.Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, andprovider/supplier have been addressed.Provides a fair and impartial decision based on cu

Easy Apply

Contract

Depends on Experience

Medicaid MCO Strategy & Oversight Consultant, Remote

Remote

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3d ago

Title:Medicaid MCO Strategy & Oversight Consultant, RemoteLocation:RemoteLength:Long termRestriction:w2 or c2c Description: Webcam interview long term project; initial PO for 1 year with multiyear extensions Remote Job DescriptionRecommend and develop standards related to MCO oversight and monitoringIdentify inefficiencies in the current MCO operations, including process mapping to identify gaps and redundanciesAssist with drafting policy, contract amendments and other documents needed to suppor

Easy Apply

Contract

Depends on Experience

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utilization management jobs in Montana, USA