• Managed Care Quality Manager, MI - Hybrid…

    McLaren Health Care (Flint, MI)
    …**Preferred:** + Five (5) years progressive experience in a leadership role in group health plan operations . + Two (2) years' experience with accrediting ... of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a… more
    McLaren Health Care (07/16/25)
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  • Senior Medical Director, Network Performance

    Banner Health (Phoenix, AZ)
    …years relevant experience. PREFERRED QUALIFICATIONS At least three years working either within health plan operations , a clinically integrated network, a ... Health Delivery. Interface with our payers in Joint Operations Councils and related operational meetings to exceed performance...of care and setting the clinical goals/vision for the plan and adhering to all guidelines and regulations set… more
    Banner Health (07/24/25)
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  • Home Health RN Clinical Manager

    Sea Mar Community Health Centers (Seattle, WA)
    …designation of priority objectives for the Home Health Division. + Develop the Home Health plan for clinical operations and provide for efficient use of ... community. Essential Duties and Responsibilities: + Planning: + Develop the Home Health Division plan for clinical operations and provide for efficient use… more
    Sea Mar Community Health Centers (07/22/25)
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  • Mental Health Parity Clinical Analyst…

    WTW (Boston, MA)
    …processes, network management, credentialing, quality management, pharmacy prior-authorization processes and health plan operations + Basic understanding of ... and welfare plans, ideally gained in a benefit consulting/brokerage firm, Health Plan , Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or… more
    WTW (07/15/25)
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  • Director Reimbursement Design & Market Evaluation

    Highmark Health (Baton Rouge, LA)
    …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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  • Senior Counsel / Assistant Vice President, Legal…

    RWJBarnabas Health (West Orange, NJ)
    …managed care organization experience + Deep expertise in managed care contracting, health plan operations , and regulatory frameworks governing provider-payer ... Care ContractingReq #:0000206244 Category:Professional / Management Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services Department:General Counsel Office Pay Range:$175,000.00 -… more
    RWJBarnabas Health (07/04/25)
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  • Clinical Pharmacist Sr.

    Elevance Health (Mason, OH)
    …for this position. **Preferred Qualifications, Skills, and Experiences:** + Strong expertise in health plan operations highly preferred. + Pharmacy benefit ... Experience with medical drug cost containment or formulary strategy in a health plan or PBM setting highly preferred. + Strong working knowledge of… more
    Elevance Health (07/25/25)
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  • Medical Director, Clinical Review and Care…

    MVP Health Care (Tarrytown, NY)
    …of 5 years of clinical practice experience + Managed care, utilization management, or health plan operations experience preferred. + Experience working in a ... environment + Previous medical director or clinical leadership experience within a health plan preferred + Strong organizational, communication, and writing… more
    MVP Health Care (08/04/25)
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  • Member Services Advocate

    Convey Health Solutions (Fort Lauderdale, FL)
    …meet the needs of government-sponsored health plans. OUR MISSION To improve health plan operations and elevate the customer experience. OUR VISION ... services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan . Place… more
    Convey Health Solutions (07/24/25)
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