• Chief Medical Officer, Population Health

    Sutter Health (Emeryville, CA)
    …this opportunity: The Chief Medical Officer (CMO), Population Health Services and Health Plan Operations , is a senior executive responsible for providing ... dually partnered in dyadic pairings with administrative leaders over population health services and plan operations , respectively, and serves as a key… more
    Sutter Health (07/25/25)
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  • Vice President of Health Plan

    Prime Healthcare (Ontario, CA)
    …team! Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for ... across all aspects of the Employee Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the… more
    Prime Healthcare (05/13/25)
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  • Director Reimbursement Design & Market Evaluation

    Highmark Health (Sacramento, CA)
    …and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations . **ESSENTIAL RESPONSIBILITIES** + Perform management ... business. This will require aligning new models to the health plan 's strategic objectives based on a...Plan , organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and… more
    Highmark Health (07/30/25)
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  • Vice President, Pharmacy, Value Based Care

    Sutter Health (Sacramento, CA)
    …relationships. + Strong knowledge of federal and state regulations affecting pharmacy and health plan operations . + Familiarity with value-based payment ... + Minimum of 7 years of progressive leadership experience in pharmacy operations within a health plan , hospital system, or integrated delivery network. +… more
    Sutter Health (07/05/25)
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  • Account Manager, Delegation Oversight Program

    UCLA Health (Los Angeles, CA)
    …healthcare operations , highly desired * 5 or more years of experience in health plan operations , compliance, or delegation oversight, required * In-depth ... delegated entities adhere to regulatory standards, contractual obligations, and UCLA Health policies. * Utilize performance data to identify areas for improvement… more
    UCLA Health (07/16/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …- 5+ years clinical experience required. - 3 years Utilization experience required in health plan /UM operations , Acute or subacute utilization review. - ... - Supervises the use of established criteria sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies… more
    Dignity Health (06/20/25)
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  • Director Clinical Analytics

    Dignity Health (Bakersfield, CA)
    …**Qualifications** **Minimum Qualifications:** - Minimum five (5) years of experience in the health plan and/or healthcare operations industry with extensive ... of the organization including but not limited to analysis of population health metrics, network clinical, financial, utilization, and patient satisfaction in support… more
    Dignity Health (07/30/25)
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  • Manager of Revenue Integrity Compliance

    Prime Healthcare (Ontario, CA)
    …and state financial reporting regulations. + Collaborate with cross-functional teams including Health Plan Operations , Patient Access, Marketing, IT, and ... Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare...implement, and manage the Revenue Integrity & CDM Compliance Plan . + Ensure compliance with CMS Price Transparency Rule… more
    Prime Healthcare (07/23/25)
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  • Information Technology Development…

    LA Care Health Plan (Los Angeles, CA)
    …$105,267.00 (Min.) - $139,478.00 (Mid.) - $173,689.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... Information Technology Development Operations Engineer II Job Category: Information Technology Department:...County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million… more
    LA Care Health Plan (07/06/25)
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  • Senior Operations Manager, Plan

    CVS Health (Sacramento, CA)
    At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...day. Oversees the day-to-day management and leadership of the plan document drafting team. Develops and coaches the team… more
    CVS Health (07/28/25)
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