Remote Clinical Review Pharmacist Pharmacy CareersRemote Clinical Review PharmacistLos Angeles, CaliforniaRemoteAbout Us We are a confidential healthcare organization providing managed-care and pharmacy review services across the U.S. Our pharmacists ensure the right medication reaches the right patient at the right time. Remote Clinical Review Pharmacist – Work From Home | Evidence-Based Decisions | Flexible Schedule Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role.
Drug Utilization Review (DUR) Pharmacist – Remote Pharmacy CareersDrug Utilization Review (DUR) Pharmacist – RemoteLos Angeles, CaliforniaRemoteRemote DUR Pharmacist – Safe & Cost-Effective Medication Use | Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers — all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical analysis and want to improve outcomes at scale.
Account Executive (Remote: California) Santa Monica, Beverly Hills, Los Angeles, Woodland Hills and Van Nuys Vitu IncAccount Executive (Remote: California) Santa Monica, Beverly Hills, Los Angeles, Woodland Hills and Van Nuyssanta monica, CARemoteFull timeThe Account Executive position is held by a dynamic, highly motivated, service-oriented individual providing training and “white glove” service focused on making clients’ lives easier with the ultimate result of increased software utilization/revenue generation, client retention, and stellar Vitu reputation. Vitu has opportunities in California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Minnesota, Montana, North Carolina, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Virginia, and Wisconsin.
Senior Accountant - Pharmacy (REMOTE) SCAN Health PlanSenior Accountant - Pharmacy (REMOTE)Long Beach, CaliforniaRemoteSupport month-end close activities for the Medicare Part D (pharmacy) business unit, including journal entries for pharmacy claims, manufacturer rebates, Direct and Indirect Remuneration (DIR) fees, manufacturer discount program, plan-to-plan payments and Part D settlement estimates with CMS. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
NewAVP, Medical Economics - REMOTE Molina Healthcare IncAVP, Medical Economics - REMOTECARemoteAdvanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. Leads and directs Strategic and Clinical Analytics team members in Medical Economics who are responsible for healthcare analytics and program evaluation, translating complex data into actionable insights that inform clinical, operational, and strategic decision-making.
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.
NewSenior Staff Medical Writer (Remote) Stryker CorpSenior Staff Medical Writer (Remote)Los Angeles, CARemote$110,100–$183,400 / yearHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. This position partners closely with Regulatory Affairs, Clinical Affairs, Quality, Research & Development, and Marketing teams to translate complex clinical evidence into high-quality regulatory and scientific documents throughout the product lifecycle.
Actuarial Consultant (Finance & Actuarial) - REMOTE Molina Healthcare IncActuarial Consultant (Finance & Actuarial) - REMOTECARemoteProvides subject matter expert level consultant expertise for actuarial function activities including extracting, analyzing, and synthesizing data from various sources to identify risks. Proficient in Microsoft Office suite products, including key skills in Excel (VLOOKUPs and pivot tables), and applicable software program(s) proficiency.
Engineer, EIS - Endpoint Security - Remote Molina Healthcare IncEngineer, EIS - Endpoint Security - RemoteCARemoteBuilds company specific systems and technology expertise across multiple infrastructure and development disciplines. Contributes to solution architecture delivery within project management methodologies and timelines.
[Remote] Senior Site Reliability Developer- USC Required Oracle Corp[Remote] Senior Site Reliability Developer- USC RequiredCARemote$91,400–$187,000 / yearOracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle''s differing products, industries and lines of business. We're looking for engineers who enjoy solving production problems at scale, improving system reliability through automation, and building infrastructure that directly supports patient care.
Manager, Actuarial Services - REMOTE Molina Healthcare IncManager, Actuarial Services - REMOTECARemoteActivities include extracting, analyzing, and synthesizing data from various sources to identify risks and opportunities; also supports analysis and reporting to operational and finance partners. Proficient in Microsoft Office suite products, including key skills in Excel (VLOOKUPs and pivot tables), and applicable software program(s) proficiency.
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.
Senior Architect, Information Systems - Databricks - Remote Molina Healthcare IncSenior Architect, Information Systems - Databricks - RemoteCARemoteDrive architecture strategy, platform modernization, and solution delivery while partnering with business and technology leaders to build scalable, secure, AI-ready data platforms. Hands-on technology leader who can define the vision, lead delivery, and drive adoption of modern data solutions.
Senior Specialist, Coding (Remote) Molina Healthcare IncSenior Specialist, Coding (Remote)CARemoteJob Description: The Senior Specialist, Coding Research supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes.
Senior Architect, Artificial Intelligence Security - AI Implemenation - Remote Molina Healthcare IncSenior Architect, Artificial Intelligence Security - AI Implemenation - RemoteLos Angeles, CARemoteExperience designing Generative AI (GenAI) solutions, with experience in Machine Learning Operations (MLOps), Large Language Models (LLM), OpenAI, CoPilot Studio, Agentic AI frameworks such as Langchain, LangGraph and Agent Development Kit (Google ADK), Data Foundry, and Data Fabric. Agentic AI Security: Leads the threat modeling, risk assessment, and security control design for autonomous AI agents, focusing on mitigating risks such as prompt injection, tool abuse, and uncontrolled agentic behavior.
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.
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.
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).
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.
Principal Architect, Enterprise - AI Transformation/SaaS/PaaS - Remote Molina Healthcare IncPrincipal Architect, Enterprise - AI Transformation/SaaS/PaaS - RemoteCARemoteParticipates as a top level technical expert in leading multiple consulting projects or a single large/complex project and ensures the success of enterprise-level application roll outs. Has significant experience in system development and has developed a broad and deep expertise in software, hardware, data and technology across multiple platforms.