Utilization Jobs

Prime Therapeutics is hiring a remote Clinical Staff Pharmacist to conduct clinical evaluations for prior authorizations and support utilization management across delegated products.

Serve as the senior regional clinical executive for CDPHP, leading physician teams and partnering across the organization to drive clinical quality, regulatory compliance, and value-based care in the Albany market.

Inclusive & Diverse

Empathetic

Mission Driven

Collaboration over Competition

Growth & Learning

Experienced payer-focused account leader needed to grow and optimize clinical program adoption and revenue across assigned health plan accounts in a remote-first telehealth company.

Serve as the operational hub for clinician and CDS scheduling, ensuring timely, accurate coordination of services and strong communication across clinical, operations, and family stakeholders.

Risant Health seeks an experienced Healthcare Operations Specialist to implement enterprise care delivery standards, support operations leaders across partner systems, and lead onsite assessments and process improvement efforts.

Lead SCAN's clinical application modernization and cloud strategy to drive interoperable, efficient care and improve operations across clinical and utilization management platforms.

Lead and scale a consultative PMO that drives predictable, profitable delivery and positions project managers as strategic, client-facing advisors across a Microsoft-focused consulting practice.

Ekimetrics seeks an Operations Manager in New York to coordinate staffing, monitor utilization and capacity, and ensure accurate reporting to keep AI-driven delivery teams well-resourced and ready.

Lead financial oversight and ROI tracking for Utilization Management initiatives at Oscar, translating complex data into executive-ready insights that drive affordability and MLR outcomes.

Support Toyota’s marketing fleet operations and compliance by coordinating vehicle logistics, documentation, and agency collaboration to enable safe, policy-compliant marketing activities.

Centene is seeking a part-time Medical Director (MD/DO) licensed in Mississippi to lead utilization management, quality improvement, and complex case review for Medicaid and Medicare members.

Lead a team of business analysts to translate CMS-0057-F regulatory requirements into FHIR-based API specifications, RTMs, and production-ready UM workflows for ProArch.

The Services Resource Advisor at CDW manages resource allocation, capacity planning, and supplier engagement to drive customer satisfaction and project profitability across sales and services.

Lead and grow enterprise employer partnerships at a mission-driven mental healthcare company, owning retention, engagement, and measurable utilization across a defined book of business.

Experienced Registered Nurse with case management certification needed to lead care coordination and case management activities at Mountain Home AFB, supporting optimal continuity of care and compliance with DoD/AF/DHA standards.

Lead and scale Directive’s paid media division by managing Associate Directors, owning account health and client relationships, and building the systems that drive consistent performance.