Managed Care Jobs

Highmark is hiring a Credential Delegation Analyst to manage delegated credentialing programs and ensure NCQA and regulatory compliance across delegated entities.

Lead First Health as Executive Director with full P&L accountability, driving provider network strategy, contracting, and a 70-person team to deliver $100M in annual revenue.

AbbVie seeks a field-based Specialty Representative in Psychiatry to manage territory accounts, deliver brand objectives, and build trusted clinical relationships to drive patient-centered outcomes.

Experienced licensed clinician sought to lead multi-site behavioral health services across a Los Angeles County region, providing clinical oversight, staff supervision, and program development.

Humana is hiring an LSW Field Care Manager to perform in-home assessments and coordinate care for Medicare/Medicaid members across Wayne and Macomb counties.

Lead Genentech’s GenAI content strategy and product advancement to scale efficient, compliant, customer-led marketing content across commercial and medical channels.

Field-based specialty sales role responsible for executing psychiatry brand strategy, managing territory accounts, and driving clinical and commercial performance in the Nashville area.

Lead the East region migraine commercial efforts as an Area Sales Director, directing field strategy, coaching leaders, and delivering measurable business growth for AbbVie.

Experienced commercial leader sought to lead West Coast migraine sales, deliver results across short- and long-term growth horizons, and develop high-performing field teams for AbbVie.

Guardant Health seeks a Strategic Account Manager to drive Shield screening adoption across major IDNs and health systems in the Central East region through executive-level relationship building and cross-functional program execution.

Strategically drive adoption of Guardant Health’s Shield cancer screening solution across major IDNs and health systems in the South Central U.S. through executive engagement, cross-functional execution, and quota-driven account leadership.

Lead enterprise provider partnerships with national health systems to expand Tendo's MDsave Marketplace, driving new-logo acquisition and measurable revenue growth.

Novartis seeks an experienced field-based Access & Reimbursement Manager to support cardiovascular products across Nebraska, Iowa and mid-Missouri by driving payer strategy, buy-and-bill workflows and patient support integration.

Guardant Health is seeking a Strategic Account Manager to lead Shield adoption and strategic partnerships across Northeast health systems and IDNs, delivering measurable growth and system-level integration.

Tutera Senior Living & Health Care is hiring a Revenue Data Analyst to produce, validate, and communicate revenue reporting and insights for skilled nursing and senior living operations.

Dyne Therapeutics is seeking a strategic commercial leader to build and lead US Market Access and Patient Services for upcoming neuromuscular therapy launches.

Humana seeks an experienced licensed social worker to deliver telephonic behavioral health care management for Illinois members, coordinating care and providing clinical guidance to improve member wellbeing.

Lead network gap analysis, provider contracting support, and operational coordination to strengthen USC’s health plan network and advance value-based care initiatives.

Pfizer is recruiting a remote Gastroenterology Health & Science Sales Specialist based near Providence, RI to lead product launch activities and engage HCPs and KOLs across virtual and face-to-face channels to drive patient access and sales.

Lead and supervise LTSS Provider Services in Albuquerque, ensuring compliant claims processing, effective provider education, EVV oversight and strong cross-functional collaboration.

Lead AHF’s health plan claims unit as the Claims Department Manager, overseeing claims adjudication, denials and appeals, team performance, and operational improvements to ensure accurate, timely reimbursement.

Field-based Specialty Representative (Psychiatry) to manage territory in Mentor, OH, execute brand strategy, build clinical relationships, and achieve sales and KPI targets for AbbVie.

Northwestern Medicine is hiring an on-site Utilization Reviewer for Behavioral Health Services to manage precertification, continued stay reviews, discharge planning communication, and insurer appeals.

Oak Street Health is hiring a Patient Relations Analyst to guide Medicare patients through coverage, benefits, and billing while acting as the clinic resource for insurance and eligibility questions.

Join VillageMD as a Credentialing Specialist to own payer credentialing, privileging, and provider data management for a growing, value-based care organization.

Senior market access leader needed to drive Medicaid payer strategies, coverage, and contracting across Western U.S. fee-for-service Medicaid programs for a fast-growing biopharma.

Experienced field-based pharmaceutical sales professional wanted to drive migraine specialty brand performance across the Birmingham metro territory while building strong provider relationships and maximizing patient access.

AbbVie seeks a results-driven Specialty Representative (HCV) to manage a San Antonio territory, execute brand tactics, and build strong provider relationships to drive sales and access.

Senior marketing leader to define portfolio strategy and lead commercialization and go-to-market execution for therapy selection and MRD/ctDNA products within Exact Sciences' Precision Oncology commercial organization.

Vertex is hiring a Commercial Rebate Operations Manager to own contract administration, rebate validation and financial analytics while building automation and partnering across commercial, legal, data and finance teams.

Lead and operationalize strategic partnerships across California—translating opportunities with MCOs, LEAs, DHCS, and CBOs into implemented, sustainable service models for Kooth.

Conifer Health is hiring a remote Patient Account Representative to research claims, perform insurance and patient collections, and resolve account issues across the revenue cycle.

Conifer Health is hiring a Payment & Research Representative to manage payment posting, reconciliations, and unapplied account research for our reimbursement and cash management operations in a remote capacity.

Experienced denials-focused revenue cycle specialist wanted to validate EOBs, generate appeals, and escalate payment trends for a national healthcare services provider.

Conifer Health is hiring an AR Follow Up Representative to remotely manage patient account workflows, resolve claims, and drive insurance and patient collections.

Join OHSU's Centralized Managed Care team as a Denial Coordinator to lead denial resolution, implement process improvements, and reduce revenue cycle leakage across hospital and ambulatory services.

American Specialty Health seeks a remote Sr Reconciliation Representative to research and reconcile complex two-step claims and payments from health plan payors.

Client Services Manager I at American Specialty Health — serve as the primary client contact for fitness program implementations and ongoing account service in a fully remote role.

Field-based Specialty Representative (Psychiatry) for AbbVie to drive brand performance and customer partnerships across the Zanesville, OH territory.

Support patients and clinical teams at OHSU by managing insurance verification, prior authorizations, and patient liability estimates within the Centralized Managed Care & Price Estimates department.

Lead and optimize Patient Business Services at a major academic health system, ensuring efficient billing, strong cash collections, and excellent customer service.

Lead Centene's Pennsylvania plan as President & CEO, directing operations, strategy, contracting, and stakeholder relations to advance member health and organizational performance.

Field-based specialty representative supporting psychiatry products in the Florence, SC territory, responsible for executing brand strategy, building provider relationships, and delivering sales results.

Labcorp is hiring a commercially minded VP/GM to lead the Mid America Division from Dallas, overseeing a $400M+ P&L and a 600+ person organization to drive growth, operational excellence, and strategic partnerships.

Takeda is hiring a Regional Territory Manager to lead clinical and commercial engagement with gastroenterology providers across Wisconsin to grow specialty product use and support patient outcomes.

Prime Healthcare is looking for an experienced Account Resolution Specialist in Lynwood to lead managed care and commercial account follow-up, resolve billing issues, and interpret payer contracts.

AbbVie is hiring a field-based Specialty Representative in Gastroenterology to manage territory performance across Oklahoma by executing strategic call plans, developing customer relationships, and meeting sales targets.

CVS Health is hiring a remote Utilization Management Nurse Consultant (Behavioral Health) to conduct clinical reviews, manage prior authorizations, and apply evidence-based criteria for behavioral health and substance abuse services.

ConcertoCare is hiring an RN Case Manager in New York to coordinate care for medically and socially complex patients within innovative, value-based care models.

Lead commercial efforts and develop high-performing field teams in the Austin/San Antonio territory as a District Manager driving sales growth and market strategy for AbbVie.