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36 fresh jobs found

Director, Network Contracting & Services
Remote

Provider management Healthcare Strategy Contracting Strategies Network performance Quality care Provider Contracting Network development Cost Containment Healthcare Delivery +25

Exec Senior Full Time

USD 142K+

Senior Director, Network Contracting & Services
Remote

Network Contracting Contracting Strategies Healthcare Strategy Quality care Network performance Provider Contracting Network development Provider Relations Cost Containment +28

Senior Full Time

USD 192K+

Virtual Physician (MD/DO)
Remote

Health outcomes research Functional medicine MacBook Charting DO MD Next Family Medicine Tech-savvy +15

USD 160K+

Manager, Risk Adjustment
Remote

Risk Adjustment Coding Continuity of care Clinical documentation improvement Risk Adjustment ICD-10-CM Data Validation Technology Platform Electronic Health Records Medical Records +22

USD 88K+

Operations Analyst, Plan Loading
Remote

Medical Coding Concepts Health Plan Benefit Concepts Google Slides Google Docs Medical Coding Technology Platform HCPCS ICD-10 CPT +21

Entry Mid Full Time

USD 54K+

Utilization Review Nurse
Remote

Care engagement Level of care reviews Milliman care guidelines Medical necessity reviews Evidence-Based Guidelines Clinical Guidelines Clinical Review RN licensure Technology Platform +13

USD 70K+

Senior Specialist, Risk Adjustment Coder
Remote

Electronic medical record systems Risk Adjustment Coding Medical Record Review Risk Adjustment ICD-10-CM Technology Platform Data Validation ICD-10 Efficiency +12

Senior Mid Full Time

USD 65K+

Clinical Supervisor
Remote

UM guidelines Milliman care guidelines Navigation Clinical Leadership Technology Platform LCSW Social Work Operations Management Health Insurance +26

USD 88K+

Operations Associate, Claims Design
Remote

Claims design Claims Adjudication Technical Implementation Technology Platform Knowledge Management Models Lean Six Sigma Process design KPI development +33

USD 88K+

Team Lead, Knowledge Management Operations
Remote

Operational KPIs Insurance experience Technology Platform Knowledge Management Administrative Tasks Lean Six Sigma Operational Improvements Six Sigma KPIs +23

Senior Mid Full Time

USD 54K+

Senior Learning Specialist
Remote

Insurance experience Training Design Adult Learning Theory ELearning Technology Platform Instructional Design PMP Six Sigma Content development +13

Senior Mid Full Time

USD 65K+

Director, Member & Provider Programs
Remote

Healthcare Strategy Program Design Technology Platform Financial Performance Management consulting Cross-functional Leadership Team Development Google Sheets Health Insurance +20

Exec Senior Full Time

USD 156K+

Data Scientist II
Remote

Models Technology Platform Statistical modeling Advanced Analytics Data Pipelines Data processing Health Insurance Data Modeling Technical Expertise +15

USD 131K+

Senior Manager, Data Science
Remote

Data Pipeline Development Quality care Technology Platform Models Statistical modeling Efficiency Operations Management Clinical operations Advanced Analytics +23

Senior Full Time

USD 174K+

Workforce Management Production Project Lead
Remote

Matrixed organization Contact center systems IEX Healthcare quality Workflow Design Workforce management Technology Platform Lean Six Sigma Project Coordination +22

Senior Mid Full Time

USD 65K+

Operations Associate, Claim Design & Configuration
Remote

Claims design Healthcare Claims Workflow Design Models Technology Platform Lean Six Sigma KPI development Claims processing Technical Design +27

USD 88K+

Physician Reviewer, Utilization Management
Remote

Medical necessity criteria Workflow Tools Evidence-Based Guidelines Clinical Review Clinical Acumen Technology Platform Utilization Review Clinical Practice Utilization management +11

Senior Full Time

USD 211K+

Manager, Member & Provider Compliance
Remote

Operational integrity Regulatory Audits Team Mentoring Macros Technology Platform Lean Six Sigma Knowledge Management Six Sigma Policy Development +25

Senior Mid Full Time

USD 92K+

Vice President, Network Operations
Remote

Provider Audits Data quality control Network performance Governance Processes System Optimization Network Operations Technology Platform Reporting tools Capacity planning +36

Exec Senior Full Time

USD 255K+

Senior Regulatory Analyst
Remote

Hios SERFF Technology Platform Health Insurance Regulatory Regulatory Compliance Monitoring C SQL +6

Senior Mid Full Time

USD 66K+

Associate, Pharmacy Policy Development
Remote

Pharmacy Policy Quality care Clinical Policy Clinical evidence Prior authorizations MCG Medical Writing Medical Coding Technology Platform +17

USD 113K+

Senior Manager, Insurance Product Development
Remote

Plan Design Models Business Insights Technology Platform Actuarial science Portfolio Management Healthcare industry Health Insurance Competitive analysis +27

Senior Full Time

USD 129K+

Senior Data Scientist
Remote

Models Statistical modeling Technology Platform Advanced Analytics Data processing Data Pipelines Health Insurance Data Modeling Equity +13

Senior Full Time

USD 158K+

Senior Claims Quality Control Analyst
Remote

Database languages Total quality management Healthcare Claims Models Business Insights Healthcare operations Lean Six Sigma Workflow Management Technology Platform +32

Senior Full Time

USD 65K+

Senior Manager, Data Analytics
Remote

Network performance KPI KPI Frameworks Quality care Contracting Strategies Models Data Storytelling Healthcare Analytics Technology Platform +34

Senior Full Time

USD 129K+

Technical Implementation Associate
Remote

Client Data Management Models Data Pipeline Technical Implementation Campaign Development Technology Platform Solution Design Scalability Health Insurance +15

USD 98K+

Director, BPO Strategy & Governance
Remote

BPO Strategy Operational improvement Technology Platform Cross-functional Leadership Transformation Six Sigma Lean Root Cause Analysis Health Insurance +20

Exec Senior Full Time

USD 156K+

Manager, Pharmacy Policy
Remote

Pharmacy Policy Quality care Clinical Policy Clinical evidence MCG Medical Writing Technology Platform Prior authorization Quality improvement +23

USD 131K+

Senior Director, Insurance Financial Management
Remote

Financial strategy Strategic Analysis Management Reporting Technology Platform Financial Performance Efficiency Contracting Financial Management Managed Care +23

Senior Full Time

USD 172K+

Senior Director, Pharmacy & Behavioral Health Program Operations
Remote

Technology Platform Cost Management Controls Transformation Efficiency Pharmacy Regulatory requirements Health Insurance Regulatory +22

Senior Full Time

USD 172K+

Senior Sales Executive
Remote

Broker management Technology Platform Healthcare industry Health Insurance Spanish Market Research Bilingual Relationship building C +9

Senior Full Time

USD 88K+

Senior Software Engineer I
Remote

CS concepts Modular code Fault-tolerant systems Scalable software Technology Platform Technical Design Health Insurance Application Development Equity +10

Senior Full Time

USD 158K+

Senior Director, Strategic Finance & Corporate Development
Remote

Qualitative evaluation Quantitative evaluation Financial targets Corporate Development Capital modeling Strategic Insights Insight Generation Corporate strategy Mergers and acquisitions +24

Senior Full Time

USD 172K+

IT Internal Audit Associate Director
Remote

Technology risk management System Development Life Cycle IT Audit Electronic Health Records Technology Platform Internal Audit Cyber Security Health Insurance Data privacy +13

Entry Senior Full Time

USD 142K+

Appeals Review Nurse
Remote

NCCN Medical decision support tools Level of care reviews Medical necessity reviews Milliman care guidelines Evidence-Based Guidelines InterQual MCG Clinical Guidelines +16

Entry Mid Full Time

USD 70K+

Director, Market Management
Remote

Market economics Healthcare Contracting Workflow improvement Financial Performance Technology Platform Contracting Healthcare industry Health Insurance Equity +12

Exec Senior Full Time

USD 156K+

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