• 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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  • Producer Management Strategy Consultant

    Highmark Health (Pittsburgh, PA)
    … Network and other affiliated Health Systems, Product & Healthcare Services, Health Plan Operations , Actuarial Services, and Government and Commercial ... educate and engage broker community; support continued development and refinement of health plan 's distribution strategy, utilizing an internal matrixed network… more
    Highmark Health (07/12/25)
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  • Plan President - Wisconsin

    Molina Healthcare (Green Bay, WI)
    …strategic and operating plan ; providing day-to-day leadership and management of the health plan market or product operations that mirrors the company's ... **Job Description** **Job Summary** Molina Health Plan Operational Leadership roles provide...operations of the market or product of the health plan . **Job Duties** The Plan… more
    Molina Healthcare (07/25/25)
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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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  • Emory Health Plan , Senior Director…

    Emory Healthcare/Emory University (Atlanta, GA)
    …diversity and excellence of our academic community. **Description** The Senior Director of Clinical Operations for the Emory Health Plan (EHP) will partner ... refine those programs. + The Senior Director of Clinical Operations will collaborate closely with the Emory Population ...Operations will collaborate closely with the Emory Population Health Collaborative leader and CM leaders to design and… more
    Emory Healthcare/Emory University (07/03/25)
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  • Production Worker

    Convey Health Solutions (Waco, TX)
    …meet the needs of government-sponsored health plans. OUR MISSION To improve health plan operations and elevate the customer experience. OUR VISION ... education degree (GED) About Us WHO WE ARE Convey Health Solutions manages a myriad of administrative needs and...myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for… more
    Convey Health Solutions (07/28/25)
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  • Sr. Data Analyst

    Convey Health Solutions (Chicago, IL)
    …the administration, compliance, and member engagement of health plans, offering scalable and flexible solutions that support health plan operations . ... lives. Therefore, we offer a competitive total rewards package, which includes health and welfare benefits, 401(K) savings with employer matching, paid time off,… more
    Convey Health Solutions (05/30/25)
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  • Business Development Specialist

    Sanford Health (Sioux Falls, SD)
    …Will be required to work cross-functionally with leaders within the organization's executive, health plan , marketing, operations , and finance teams, among ... **Careers With Purpose** **Sanford Health is one of the largest and fastest-growing...plans to solve or take advance of them. Research, plan , implement, monitor, track, and support new or expanded… more
    Sanford Health (07/31/25)
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  • Vice President, Columbia Pacific CCO

    CareOregon (Portland, OR)
    … care costs, health outcome measures such as HEDIS and CAHPS, and health plan operations , such as claims payment, customer service, medical management, ... Coordinated Care Organization (CPCCO), providing services under the Oregon Health Plan , Healthier Oregon Program and/or Basic...care services, changes in the legal/legislative arena that impact operations + Health care public policy issues… more
    CareOregon (07/10/25)
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  • Senior Management Engineer (Provider Network)…

    Henry Ford Health System (Troy, MI)
    …matrixed working environment. Additional Information + Organization: HAP ( Health Alliance Plan ) + Department: Provider Network Operations + Shift: Day Job + ... emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans… more
    Henry Ford Health System (08/02/25)
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