NewManager Of Provider Transition And Growth - Remote Within The Los Angeles Metro Area UnitedHealth Group Inc.Manager Of Provider Transition And Growth - Remote Within The Los Angeles Metro AreaTorrance, CARemote$72,800–$130,000 / yearThe Manager of Provider Transition and Growth, is responsible for leading and overseeing all membership movement activities associated with Primary Care Provider departures, retirements, panel updates, site closures, and strategic provider realignment initiatives across the Optum CA market. Partner extensively with Operations, Provider Network, Market Leadership, Compliance, and external stakeholders to ensure accurate and timely membership movement.
REMOTE Utilization Management Pharmacist, Oncology Starling OncologyREMOTE Utilization Management Pharmacist, OncologyCerritos, CARemote$144,000–$170,000 / yearThe pharmacist partners with pharmacy leadership, physicians, advanced practice providers, revenue cycle management, informatics, and utilization management compliance teams to align medication review processes, pathway logic, evidence requirements, and operational workflows. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations.
NewAssociate Director Business Process - Claim And Appeal Operations - Remote In US UnitedHealth Group Inc.Associate Director Business Process - Claim And Appeal Operations - Remote In USLos Angeles, CARemote$112,700–$193,200 / yearThe Associate Director Business Process operates in a highly matrixed environment, managing complex initiatives, advancing cost-efficiency strategies, and delivering data-driven insights that inform decision-making and improve operational outcomes across Claim & Appeal Operations. The Associate Director Business Process, Claim & Appeal Operations serves as a key strategic partner to the Claim & Appeal Operations VP, driving execution of operational, financial, and strategic priorities across the organization.
NewAssociate Director, Network Pricing - Remote In PST Or MST UnitedHealth Group Inc.Associate Director, Network Pricing - Remote In PST Or MSTCypress, CARemote$112,700–$193,200 / yearThe Associate Director of Healthcare Economics - Network Pricing supports Provider Network contracting and unit cost management activities through financial modeling, analysis of utilization, and reporting (VBC agreements, physicians, hospitals, pharmacies, ancillary facilities, shared/full risk delegation, etc.). Required Qualifications: 5+ years of experience in creating and using financial modeling tools, spreadsheets, and information acquisition tools including experience in interpreting and reviewing financial modeling results to evaluate the financial impact of contract changes and develop forecasts.
NewAppeals Medical Director - Remote UnitedHealth Group Inc.Appeals Medical Director - RemoteCypress, CARemote$248,500–$373,000 / yearTotal cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues.
Project Management Data Specialist - Remote Sun River Health IncProject Management Data Specialist - RemoteCARemote$21–$24.35 / hourThe Project Management Data Specialist will be responsible for leveraging Sun River Health''s available data to provide a clear understanding of Sun River Health''s performance in value-based payment contracts, to drive performance improvement, and to support Sun River Health's Project Management Office (PMO) through ongoing project management. Essential Duties and Responsibilities for a Project Management Data Specialist: Retrieve and leverage available data from available and appropriate databases to provide a clear, transparent view of Sun River Health's performance in value-based payment contracts.
NewAppeals M.D. Double Boarded Med-Peds Or FM M.D. - Remote UnitedHealth Group Inc.Appeals M.D. Double Boarded Med-Peds Or FM M.D. - RemoteCypress, CARemote$248,500–$373,000 / yearTotal cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues.
Specialist, Claims Recovery (Remote) Molina Healthcare IncSpecialist, Claims Recovery (Remote)CARemoteResearches simple to complex claims payments using tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources to validate overpayments made to providers. Enters and updates recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy; processes claims as a refund or auto debit in claim systems and in recovery application.
Program Manager (Quality Strategy & Performance) - Remote Molina Healthcare IncProgram Manager (Quality Strategy & Performance) - RemoteCARemoteProvides 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 networks, as applicable. At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
Appeals M.D. - Family Or Internal Medicine Required - Remote UnitedHealth Group Inc.Appeals M.D. - Family Or Internal Medicine Required - RemoteCypress, CARemote$248,500–$373,000 / yearCommunicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
National Medical Director, Clinical AI Innovation And Performance - Remote UnitedHealth Group Inc.National Medical Director, Clinical AI Innovation And Performance - RemoteLos Angeles, CARemote$386,500–$579,500 / yearThe MD will establish efficient and consistent annotation, training and testing models to ensure medical policies are accurately interpreted, evidence based, consistently applied, and operationally effective, This role serves as the clinical authority for guideline interpretation, clarification, and enhancement, ensuring that approved medical policy and supporting evidence are translated into UM clinical criteria that enable appropriate coverage decisions, support safe and effective care, and scale across enterprise operations. MD will also be a key member of the UCS clinical and AI leadership team, collaborating on clinical program design, data models, AI use and modernization.
Investigator, Special Investigative Unit Coding (Remote) Molina Healthcare IncInvestigator, Special Investigative Unit Coding (Remote)CARemoteWorking knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
NewAppeals M.D. - Gastroenterologist Required - Remote UnitedHealth Group Inc.Appeals M.D. - Gastroenterologist Required - RemoteCypress, CARemote$238,000–$357,500 / yearTotal cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues.
NewAppeals Medical Director - Emergency Medicine Required - Remote UnitedHealth Group Inc.Appeals Medical Director - Emergency Medicine Required - RemoteCypress, CARemote$248,500–$373,000 / yearCommunicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Associate Director, Network Pricing - Remote in PST/MST UnitedHealth GroupAssociate Director, Network Pricing - Remote in PST/MSTCypress, CARemote$112,700–$193,200 / yearThe Associate Director of Healthcare Economics - Network Pricing supports Provider Network contracting and unit cost management activities through financial modeling, analysis of utilization, and reporting (VBC agreements, physicians, hospitals, pharmacies, ancillary facilities, shared/full risk delegation, etc.). + 5+ years of experience in creating and using financial modeling tools, spreadsheets, and information acquisition tools including experience in interpreting and reviewing financial modeling results to evaluate the financial impact of contract changes and develop forecasts.
NewClinical Consultant - Physician Associate - Remote UnitedHealth Group Inc.Clinical Consultant - Physician Associate - RemoteCypress, CARemote$91,700–$163,700 / yearPerform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP (The appeals are in response to adverse determinations for medical services related to benefit design and coverage, medical necessity, and the application of clinical criteria of medical policies). Primary Responsibilities: In collaboration with and supervision by an Appeals and Grievances Medical Director, the Physician Associate is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies.
Senior Manager, Patient Journey Optimization TMTT (Remote US) Edwards LifesciencesSenior Manager, Patient Journey Optimization TMTT (Remote US)Los Angeles, CARemote$142,000–$201,000 / yearDeliver high‑impact clinical education to heart teams across disease state, patient identification, treatment options, timing of intervention, and application of clinical evidence to support confident decision‑making. With millions of patients served in over 100 countries, each team makes a meaningful contribution by improving patient outcomes and discovering lasting solutions for unmet patient needs.
Bilingual/Spanish Board Certified Behavior Analyst Remote BCBA BrightSpring Health ServicesBilingual/Spanish Board Certified Behavior Analyst Remote BCBAAnaheim, CARemoteState Specific Requirements: Illinois: Board Certified Behavior Analysts (BCBA), Licensed Clinical Psychologist, Board Certified Associate Behavior Analyst (BCaBA), or a minimum of a bachelor's degree with 1500 hours of supervised experience performed by a Licensed Psychologist or BCBA. The behavior analysts, therapists, social workers, counselors, and psychologists at SpringHealth combine their expertise to deliver high-quality behavioral services for clients to live more positive, active, and social lives.
Regional Sales Manager (Remote-United States) Nextech Systems LLCRegional Sales Manager (Remote-United States)CARemoteThe Regional Sales Manager maintains strong customer relationships, delivers product demonstrations, and transitions new clients to the Client Success Manager for ongoing support. Proven experience in business development and managing full-cycle sales processes, or significant experience working in a healthcare practice within specialties like plastic surgery or dermatology.
Medicare Benefits Consultant (Korean Speaking) remote CA only Lee Hecht HarrisonMedicare Benefits Consultant (Korean Speaking) remote CA onlyLos Angeles, ALRemote$20–$25 / hourThe Medicare Enrollment Specialist serves as a trusted resource for prospective members, providing education on available healthcare coverage options and assisting individuals through the enrollment process. This role requires strong communication skills, attention to detail, and the ability to build rapport over the phone while maintaining compliance with healthcare regulations.