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142 Jobs in United States

  • Medical Director, Behavioral Health

    United States
    ... , HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk ... leadership and guidance for utilization management and case management programs for mental health and ...

  • Medical Director, Behavioral Health (Based in NM)

    Albuquerque, New Mexico
    ... , managed healthcare systems, quality improvement, medical utilization management, risk management, risk ... leadership and guidance for utilization management and case management programs for mental health and ...

  • Chief Medical Officer, Health Plan-Must reside in Arizona

    Phoenix, Arizona
    ... leadership in the development and execution of the Plan’s disease management, case management, utilization ... , including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling ...

  • Medical Director-WA Pediatrician

    Bothell, Washington
    ... healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients ... , pharmacy utilization and effective resource management. Develops and implements a Utilization ...

  • Medical Director-Must be licensed in WA

    Bothell, Washington
    ... appropriateness and medical necessity of healthcare services provided to members, targeting improvements in ... utilization practices, guideline usage, pharmacy utilization and effective resource management. Develops ...

  • AVP Clinical Operations (Remote within USA)

    Long Beach, California
    ... Job Description Job Summary Molina Healthcare Services (HCS) works with members ... education and experience Required Experience 7 years of utilization and/or case management ...

  • Clinical Appeals Nurse (RN) TEXAS and NEW MEXICO

    Texas
    ... Review / Utilization Management and knowledge of Interqual / MCG guidelines. MULTI STATE / COMPACT ... Officer on denial decisions. Resolves escalated complaints regarding Utilization Management and Long ...

  • VP, Healthcare Services -LTSS (Based in New Mexico)

    Albuquerque, New Mexico
    ... , Healthcare Services is responsible for oversight and management of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient ...

  • Pharmacy Technician - Remote (Must have National and State License)

    United States
    ... JOB DESCRIPTION Job Summary Molina Pharmacy Services/Management staff work to ... requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy ...

  • Medical Director (Remote-Must have licenses in TX, WA, FL, NM, AZ)

    United States
    ... necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction ... usage, pharmacy utilization and effective resource management. Develops and implements a ...

  • Medical Director (California)

    United States
    ... , capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management ... appropriateness and medical necessity of healthcare services provided to members, targeting improvements in ...

  • Maternal & Child/EPSDT Coordinator (RN) - Remote in NE

    Nebraska
    ... to periodic preventative healthcare services for all eligible populations and is responsible for ... increase utilization of well-child visits, screenings, exams, and associated services; and improving ...

  • Manager, Healthcare Services - Virginia Medicaid

    Glen Allen, Virginia
    ... Services provides operational management and oversight of integrated Healthcare Services (HCS) teams ... productivity, cost effective utilization of services, management of targeted member population, and triage ...

  • Sr Analyst, Healthcare Analytics (EST hours)

    New York, New York
    ... presents healthcare utilization and cost containment reports and makes recommendations based on relevant ... /performance management metrics Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing ...

  • Sr Analyst, Healthcare Analytics (Remote)

    United States
    ... healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes ...
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