Browse Jobs
Browse fresh roles from company career pages, then filter by keyword, location, salary, skills, remote scope, and more. Each listing links back to the employer-controlled apply path when available.
Browse fresh roles from company career pages, then filter by keyword, location, salary, skills, remote scope, and more. Each listing links back to the employer-controlled apply path when available.
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Candidates must reside in Florida and hold an active, unrestricted nursing license in the state. This is a hybrid position requiring approximately 20% travel to hospital settings to support member needs. Applicants must have a minimum of two years of case manageme
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provider Network Administration is responsible for the accurate and timely validation, analysis, maintenance, and governance of critical provider information across claims, credentialing, contracting, and provider network systems. This role serves as a
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contribut
hckd.fa.us2.oraclecloud.com
Job Description Job Summary Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity,
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION The Sr. Analyst, Provider Data Management is responsible for analyzing and understanding business processes, identifying areas for improvement, and developing solutions to optimize performance. The Sr. Analyst often acts as a liaison between the business units an
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Do you want a career where you build lasting relationships with the people you partner with? Do you want to make a difference in the lives of people with long-term health care needs? Then TMG wants to hear from you! We’re currently looking for someone
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Description Job Summary Are you seeking a unique nursing position that gives you a great work/life balance and lets you support p
hckd.fa.us2.oraclecloud.com
Job Description Job Summary Provides subject matter expertise for identifying, developing, and operationalizing scalable cost of care and network performance initiatives across the enterprise. Leads the end-to-end lifecycle from unvetted ideas through discovery and development, i
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides peer support services for members with behavioral health needs/chemical dependency issues. In collaboration with multidisciplinary care team working across the continuum, strives to ensure member progress toward desired outcomes, and contribut
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Provides executive level strategy and leadership for teams responsible for optimization of clinical operations across the enterprise. Develops and implements processes to ensure healthcare services functions including utilization management/care management/etc. an
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties • Performs initial receipt and r
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion n
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides lead level support for core operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc., ensuring functional operations and contractual compliance. Essential Job Duties • Effectively
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support for member health assessment activities. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum, including behavioral health and long-term care for members with high-need potential
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. Essential Job Duties • Eval
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Leads and directs team responsible for the development and administration of state health plan operational functions, programs and services - ensuring functional operations, contractual compliance, and alignment with health plan member satisfaction, re
hckd.fa.us2.oraclecloud.com
Job Description Job Summary The Specialist, Patient Care Delivery is a multi-disciplinary healthcare professional who delivers high-quality, compassionate care to health plan members in their homes. This role combines clinical expertise, cultural sensitivity, and excellent commun
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Provides support and subject matter expertise for member clinical dental review activities. Responsible for determining appropriateness and medical necessity of member dental care services - targeting opportunities for quality improvement and satisfaction for memb
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contribut
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Moni
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Under supervision, applies software engineering methods and techniques to the design, development, integration, qualification and/or support of Microsoft Reporting Services, SQL stored procedures and developing areas of expertise. KNOWLEDGE/SKILLS/ABIL
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuri
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payme
hckd.fa.us2.oraclecloud.com
JOB DESCRIPTION Job Summary Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as pr