Managed Care Jobs

HealthAxis seeks a detail-oriented Utilization Review Nurse (RN) to conduct medical necessity reviews, manage concurrent inpatient cases, and coordinate with providers using InterQual and evidence-based criteria.

Field-based specialty sales role with AbbVie to drive psychiatry brand performance through strategic territory execution and trusted provider relationships.

AbbVie is hiring a field-based Specialty Representative (Psychiatry) to manage the North Savannah territory, execute brand plans, and grow access and sales through strong customer partnerships.

HealthAxis is hiring a part-time Medical Director (Utilization Management) in Tampa to lead clinical review, medical necessity determinations, and UM program improvements for payer clients.

Conduit Health is hiring a Payor Development Lead to build and execute national health plan strategy and partnerships across Medicaid and Medicare markets.

Senior executive role leading managed care contracting, strategic partnerships, M&A due diligence, and strategic finance to drive growth and operational excellence across Pennant’s healthcare portfolio.

Lead Vynca’s Enhanced Care Management program as the Director responsible for program operations, CalAIM performance, team leadership, and strategic growth.

HealthAxis is hiring a Claims Specialist in Tampa to adjudicate Medicare claims, enforce compliance, and deliver timely, high-quality service to members and providers.

Kooth is hiring a Vice President of Account Management & Partnerships to lead and scale the organization’s strategic, statewide partnership with the State of California and ensure sustained program performance and funding.

Lead AbbVie's district sales efforts across the Austin–San Antonio market to drive commercial growth, develop field talent, and execute strategic business plans.

Experienced healthcare network performance professional needed to drive post-acute strategy, vendor engagement, training, and analytics across Central Pennsylvania for Highmark's Home and Community Services division.

AbbVie seeks a field-based Specialty Representative in Psychiatry for the Chesapeake, VA territory to execute brand strategy, develop key customer relationships, and deliver measurable sales results.

AbbVie is hiring a field-based Specialty Representative in Dermatology to drive brand performance and build strong customer partnerships across the Ann Arbor territory.

AbbVie is hiring a field-based Specialty Representative in Green Bay, WI to grow eye care brand performance through targeted selling, relationship-building, and territory execution.

Pharmaceutical specialty sales role at AbbVie focused on driving migraine product performance across Northern Utah through territory management and clinician engagement.

Represent AbbVie’s specialty brand in the Harrisburg territory, driving sales performance and building clinical relationships with specialty physicians, pharmacists and nursing staff.

Lead and develop a high-performing field team in the Austin/San Antonio territory to drive sales growth, execute district strategy, and strengthen relationships with key clinical stakeholders for AbbVie.

Provider Data Coordinator I needed to maintain accurate provider records, ensure state compliance, and produce reports that support managed care network performance.

Centene is seeking a Quality Improvement Analyst (CPHQ) to lead statistical analysis and reporting of HEDIS, utilization, and quality measures using PowerBI and Snowflake/SQL.

Regeneron is seeking a results-driven Medical Specialist II with ophthalmology/retina and buy & bill experience to manage customer relationships and drive product growth across a remote territory from Des Moines to the western Chicago suburbs.

CareSource is hiring an Encounters Systems Analyst III to lead claims encounter analysis, regulatory reporting and process improvement efforts to ensure compliant, timely submissions.

CenterWell (a Humana company) seeks a BSN-prepared RN to provide telephonic care management and medication education for members with complex chronic and rare conditions.

Experienced analytics professional needed to build predictive models, forecasts and executive reporting to improve CMS Stars performance across markets.

Experienced project manager sought to lead non-technical business operations implementations across Humana's managed care organization in a fully remote, US-wide role.

Centene seeks a remote Trainer I to design and deliver contact-center training and auditing solutions that improve staff performance and member experience across multiple time zones.

Lead strategy and business development for pharma-facing initiatives at CVS Health, building business cases, managing external partners, and incubating growth opportunities to expand pharmaceutical access and reduce costs.

Experienced board-certified psychiatrist sought to serve as a part-time Behavioral Health Medical Director for New Jersey Medicaid, providing clinical leadership, utilization review oversight, and provider consultation in a hybrid/virtual capacity.

Centene seeks a Senior Director of Sales Investigations to lead and elevate enterprise-wide Medicare sales investigations, ensuring compliance with CMS and state regulations while advising senior leadership on risk mitigation.

Lead Centene's behavioral health utilization management team in a remote Florida-based Senior Director role focused on clinical quality, policy, operations, and cross-functional leadership.

Lead Wellmark's provider engagement strategy as Director of Provider Relations, guiding a team to strengthen provider partnerships, advance value-based contracting, and drive measurable improvements in quality and administrative performance.

AbbVie is hiring a field-based Specialty Representative to drive psychiatry brand performance and customer engagement in the Springfield, OH territory.

San Francisco Department of Public Health is hiring an Executive Director of Patient Financial Services to lead revenue cycle operations, compliance, and a large multi-site team across the SFHN.

Amgen is hiring a West Regional Lead, Patient Access for UPLIZNA (IgG4) to manage a field team and oversee patient access, reimbursement, and specialty distribution across the Western United States.

Humana seeks a Provider Contracting Professional 2 to negotiate and manage provider contracts, analyze reimbursement structures, and support network growth in a remote role with preference for Florida-based candidates.

Lead day-to-day operations and clinical site performance for CenterWell Clinic Roxboro, directing staff, operations, and quality initiatives to improve patient outcomes and support value-based care.

National Vision seeks a detail-oriented Managed Care Biller to manage electronic and paper claim submissions, research denials, and secure clean adjudication across payors in a hybrid role.

Lead Provider Network Operations at Presbyterian to oversee provider relationships, contract compliance, network development, and a team focused on education and engagement.

CenterWell Senior Primary Care is hiring an operations-focused Center Administrator Assistant to manage daily clinic staffing and operational activities at its Orlando primary care center.

Washington University seeks an experienced Patient Billing/Services Representative III to lead front-desk scheduling, billing, and patient-service coordination for the Heart and Vascular Center.

Humana seeks a detail-oriented Provider Contracting Coordinator to manage provider contracts, network documentation, and data auditing for Virginia-based providers in a remote capacity.

Experienced managed-care pharmacist wanted to lead pharmacy strategy, compliance, and operations for Aetna Better Health of Kentucky in a fully remote Director-level role.

Presbyterian Homes & Services is hiring an LPN Admissions Nurse to coordinate nursing admissions, ensure payer and care coordination accuracy, and support resident transitions at the Flagstone community in Eden Prairie.

Centene is hiring a Project Manager IV to lead complex telephony/IVR and contact center implementations, driving cross-functional delivery and stakeholder adoption across its national healthcare operations.

SSM Health is hiring a part-time Referral Coordinator II to handle referrals, prior authorizations, insurance verifications, and patient scheduling at the Centralia off-site physical therapy clinic.

CoxHealth Rehabilitation Hospital is hiring a Director of Business Development to lead referral strategy, mentor admissions/liaison teams, and grow inpatient rehab volume at the new Ozark facility.

Senior leader needed to manage provider contracting and network strategy across Idaho, driving complex negotiations, value-based arrangements, and strong provider partnerships for Cigna Healthcare.

CenterWell (Humana) is hiring an experienced Quality RN to lead HEDIS/Stars initiatives and quality improvement across North Charleston provider centers.

Westborough Behavioral Healthcare Hospital is seeking a Per Diem Utilization Review Specialist to manage authorizations, concurrent reviews, and discharge coordination for inpatient psychiatric patients.

Experienced Managed Care Coordinator needed to support Medicaid and dual-product members by coordinating care, ensuring compliance, and facilitating communication between members, care teams, and vendors.

AbbVie seeks an experienced Sr. Associate General Counsel to drive legal strategy for its Immunology commercial business, advising senior leadership on regulatory, compliance, and commercial initiatives.