Utilization Management Pharmacist Remote Jobs

Partner with us to enhance member health through integrated case management. You'll develop and monitor care plans, conduct assessments, and coordinate with healthcare teams to ensure optimal outcomes...

Reimagine health plan payment integrity by leading operational projects, analyzing claims data, and collaborating across teams to enhance compliance and financial outcomes. Drive strategic initiatives...

Shape your career by joining our team as a Remote RN Case Manager, where you'll provide compassionate care, develop personalized health plans, and collaborate with a multidisciplinary team to enhance...

Champion data-driven insights as you lead a multidisciplinary analytics team, driving client performance and strategic recommendations to enhance business growth and market competitiveness...

Join a dynamic team to develop and manage supply chain contracting strategies that optimize costs and enhance value for member pharmacies. This role involves supplier negotiations, category performanc...

Lead the charge in managing Time, Labor, and Travel & Expense functions, ensuring compliance and operational excellence. Collaborate with teams to enhance processes, drive analytics, and support strat...

Join a dynamic team to lead clinical management initiatives across multiple health plans, ensuring high-quality patient care and compliance with standards. Drive utilization management strategies and...

Advance mental health and substance abuse care by authorizing services, analyzing data, and coordinating discharge plans. Collaborate with clinical teams to ensure effective treatment and participate...

Manage and lead field-based medical teams, ensuring client delivery and team performance while fostering scientific engagement and program growth. Collaborate with cross-functional teams to achieve st...

Innovate the future of AI-driven revenue cycle products, leading strategy, commercialization, and product delivery. Collaborate across teams to drive adoption and revenue growth while navigating compl...

Lead the charge in optimizing coding accuracy and compliance by analyzing complex patient care documentation, providing expert guidance, and enhancing coder education to ensure adherence to ethical st...

Shape innovative solutions by leveraging your expertise in a dynamic office environment. Collaborate with cross-functional teams and contribute to project success while ensuring high standards of accu...

Join a team that's dedicated to conducting thorough medical reviews and applying clinical judgment to ensure compliance and prevent fraud in healthcare claims. Collaborate with professionals to suppor...

Lead the charge in medical management and quality improvement initiatives, ensuring optimal care delivery and cost-effectiveness. Collaborate with clinical teams to enhance utilization management and...

Drive the success of inpatient Payment Integrity programs by overseeing audits, ensuring compliance, and enhancing quality across teams and vendors. Collaborate with stakeholders to optimize processes...

Champion the future of enterprise database systems by leading design, implementation, and operational excellence. Collaborate with cross-functional teams to deliver innovative solutions while mentorin...

Lead the charge in delivering exceptional pharmaceutical care by interpreting prescriptions, consulting with patients, and ensuring quality assurance. Collaborate with healthcare professionals to opti...

Lead PBM compliance audits, ensuring adherence to state regulations and industry standards. Supervise examiners, manage client relationships, and adapt to a fast-paced environment while driving progra...

Unlock your potential by driving complex provider compensation projects, providing analytical support, and collaborating with leadership to enhance compensation strategies within a dynamic healthcare...

Drive strategic growth by managing high-impact relationships with health systems and specialty pharmacies. Lead account management, enhance client satisfaction, and identify opportunities for value ex...

Reimagine pharmacy benefit strategies as a trusted advisor, leading procurement initiatives and optimizing client programs. Oversee analytics operations while delivering actionable insights and foster...

Lead the Medicare Appeals team, overseeing daily operations and ensuring compliance. Collaborate with healthcare professionals to enhance efficiency and provide expert guidance on Medicare policies wh...

Unlock financial insights at a strategic level, driving value realization and governance for transformation investments. Collaborate across functions to enhance performance, support decision-making, a...

Empower healthcare excellence by leading clinical programs and teams. Utilize your extensive experience to enhance quality, compliance, and strategic initiatives in a dynamic environment focused on pa...

Elevate operational efficiency by leading shared service improvements and cross-functional collaboration to enhance patient and provider experiences while driving team performance and process excellen...