• Pharmacist, Utilization Management (UM) Remote…

    Molina Healthcare (West Valley City, UT)
    …3 years of experience in a pharmacy, Pharmacy Benefit Manager(PBM), formulary, and/or managed care setting, and 1-2 years post-graduate experience, or equivalent ... **Preferred Qualifications** + Medicare Part D and/or Medicaid experience. + Managed care experience Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation… more
    Molina Healthcare (12/24/25)
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  • AVP, Business Development - Hospice

    BrightSpring Health Services (Huntsville, AL)
    …contract negotiations with agencies, funding sources, facilities, insurancecompanies, and managed care organizations* Supports and promotes company philosophy ... contract negotiations with agencies, funding sources, facilities, insurancecompanies, and managed care organizations* Supports and promotes company philosophy… more
    BrightSpring Health Services (12/24/25)
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  • Appeals & Grievance Case Resolution Specialist

    AmeriHealth Caritas (Philadelphia, PA)
    care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral ... processes preferred. + 2 to 3 years experience in healthcare operations, managed care , or grievance/appeals coordination. **Other Skills** + Proficiency in… more
    AmeriHealth Caritas (12/24/25)
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  • Practice Administrator, ENT

    Beth Israel Lahey Health (Boston, MA)
    …Responsible for ensuring the accuracy of patient-related activities such as registration, managed care referrals, the collection, recording and distribution of ... procedures and protocols. + Implements relevant information systems such as managed care , ensuring accuracy of data input and patient appointments. Provides… more
    Beth Israel Lahey Health (12/21/25)
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  • Medical Director - Medicaid (Oklahoma)

    CVS Health (Madison, WI)
    …this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, California, Florida, Illinois, ... Oklahoma residency -Health plan/payor Utilization Management / Review experience. - Managed Care experience. -Medicaid experience. **Education:** -M.D. or… more
    CVS Health (12/19/25)
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  • Discharge Planner

    Prime Healthcare (North Las Vegas, NV)
    …Discharge Planning/ Utilization Management / Case Management terminology and functions, in both managed care and non- managed care environments.2. ... Vegas, Nevada. North Vista offers comprehensive healthcare services, including mental health care , emergency care , heart care , advanced surgical procedures,… more
    Prime Healthcare (12/19/25)
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  • Practice Administrator =

    Beth Israel Lahey Health (Chestnut Hill, MA)
    …Responsible for ensuring the accuracy of patient-related activities such as registration, managed care referrals, the collection, recording and distribution of ... procedures and protocols. 4. Implements relevant information systems such as managed care , ensuring accuracy of data input and patient appointments. Provides… more
    Beth Israel Lahey Health (12/18/25)
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  • Lead Investigator, Special Investigative…

    Molina Healthcare (Covington, KY)
    …lieu of education experience) + At least five (5) years' experience working in a Managed Care Organization or health insurance company + Minimum of two (2) ... and law enforcement procedures with emphasis on fraud investigations + Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace +… more
    Molina Healthcare (11/21/25)
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  • Behavioral Health Utilization Management Review

    AmeriHealth Caritas (LA)
    …of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care organization desired + Proficiency in Microsoft Office to ... to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health… more
    AmeriHealth Caritas (11/19/25)
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  • Provider Network Operations Analyst CPC

    AmeriHealth Caritas (Charleston, SC)
    …configuration process/systems and its relevance/impact on network operations. + 1 to 2 years managed care or related experience preferred. + 1 to 2 years ... to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health… more
    AmeriHealth Caritas (11/19/25)
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