This is a fully remote FTE position for a Principal IT Project Manager, which allows you to work from home from anywhere in the US.This position is responsible for providing direction to a team of IT Project Managers. Responsibilities include the administrative duties of hiring, purchasing of equipment, conducting employee reviews, staffing and other resource management tasks. Provides guidance and mentoring to staff. Participates in budget preparation and tracking. This position is responsible for providing direction to a team of IT Project Managers. Responsibilities include the administrative duties of hiring, purchasing of equipment, conducting employee reviews, staffing and other resource management tasks. Provides guidance and mentoring to staff. Participates in budget preparation and tracking. Provides direction to a team of IT Project Managers. Performs administrative duties of hiring, purchasing of equipment, conducting employee reviews, staffing and other resource...

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process...

The Sr. Director of Data Governance incrementally builds out a data governance program and manages its operational components, influencing maturity of practices and solutions. The candidate will provide leadership, guidance, direction, and oversight for solutions to secure data including Data Classification, Data Retention, and Data Loss Prevention (DLP) for structured and unstructured data. This includes environments for cloud (AWS, AZURE), Unix, Windows, Linux and Databases.  The candidate must have a technical background and be able to influence and lead in a highly matrixed environment, bringing people across Magellan together around the shared mission.  A successful candidate will have both an end state vision and maturity to help the organization progress towards that vision incrementally and purposefully. Responsibilities Leads, mentors, and guides the Organizations data governance program buildout and its individual components. Ensures the integrity and usefulness...

Responsible for assigned areas of quality within a specified unit of a Magellan Strategic Business Unit (SBU). Implements assigned quality program components. Interfaces with customers and regulatory entities. May have accreditation responsibilities based on contract requirements. Oversees clinical processes and quality clinical staff as related to clinical audits, completes quality of care reviews, and interprets clinical documentation and application of regulatory or accreditation standards. Manages day-to-day quality activities ensuring program and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contract, federal and state requirement. Supervises quality staff to ensure successful execution of projects and initiatives. Interfaces with customers, regulators or other stakeholders on quality programs, external or regulatory audits. Conducts training sessions on Continuous Quality Improvement (CQI) processes....

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process...

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process...

The Manager of Application Security is responsible for building a comprehensive Application Vulnerability Management program that includes, Secure Software Development Lifecycle, Patch Governance, and Application Security. Reporting directly to the Senior Director of Vulnerability Management, this position leads the Application Security Team. This is a fully remote position, allowing you to work from the comfort of your own home from anywhere in the US. Promotes a positive security culture for the organization by protecting the confidentiality, integrity, and availability of data and assets while assisting the company to successfully meet its strategic goals. Manages a team of Information Security Engineers and/or Analysts and is accountable for this team’s performance in engineering, implementation, and maintenance of security processes and solutions throughout the enterprise according to policy and risk. Accountable for the team’s ability to design, develop, and...

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process...

This position supports the clinical vision for the health plan(s) and implements programs to support this vision. May serve multiple health plans managed by the Clinical Center of Excellence. Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care. Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions. Follows high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care. Ensures that persons with severe, complex, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment.  Continues physician oversight of at-risk patients deemed...

Strong experience in AWS cloud and dev ops engineering skills. Good understanding how a PBMS work and relate the components to technical resources. Extensive knowledge with Amazon Linux, Red Hat Linux, S3, Network Load Balancer, Oracle RDS in AWS. Extensive knowledge in Cloud-formation template or terraform to create infrastructure as code. Support development team members for their infrastructure needs in AWS env. Review and mentor dev ops engineers. Expand knowledge across different team members. Extensive knowledge in the 5 pillars of Well Architecture Review. Extensive knowledge in linux shell scripting. Extensive knowledge in automating build, deploy, infrastructure using code pipeline. This position will provide technical leadership for the entire infrastructure engineering team to build systems utilizing automation, resiliency, and flexibility. Define the strategy that drives the infrastructure and services that let product service teams...

Strong DevOps skill set, more development experience than administration. Plan, Architect, and communicate AWS infrastructure for a transformational organization Python Development Experience Hands on development experience in AWS environment, experience designing, executing Experience with In-structure-as-code highly desirable. AWS security concepts - IAM, KMS, VPC security controls Cloud Formation/Terraform development experience. Monitor performance and capacity metrics for technology solutions while identifying and developing plans to address long term trends or issues. Maintain and Operationally support Cloud Security infrastructure across various providers such as Azure, GCP, AWS, utilizing various cloud native tools such as Prisma Cloud, CASB, DLP, Zscaler, Microsoft Advanced Threat Protection, and others. Any AWS Certification preferred, but not required AWS lambda/"serverless" development experience preferred, but not required JIRA, Agile...

This is a fully remote position, allowing you to work from the comfort of your own home from anywhere in the US. This position will analyze, evaluate and design/redesign business, IT or operational processes using scientific approaches such as Critical Thinking, Lean Management, ITIL, Design Thinking and structured systems analysis and design. Provide requirements and testing leadership for the portfolio of applications managed by an IT Service Owner. Drive requirements definition. Oversee detailed design and definition of acceptance criteria to ensure high quality deliverables. Drive usability and quality of the software developed within the area. Ensure integrity of the system is maintained despite the speed of changes. Be a hands-on analyst who can define user stories and acceptance criteria, assist with problem solving, root cause analysis, trouble shooting and coaching of junior it analysts on the team. Develop relationships with senior stakeholders across partner...

ITIL exposure - Ability to work support the operations processes for API based interfaces. Ability to perform RCA - Root Cause Analysis Technical skills like AWS, iSeries and other exposure This position services as an expert technical and industry resource to management, clients and development staff in new uses of information technology in all phases of major system and subsystem development. Provides consultation on internal and industry IT technical and business domain process capabilities including leadership in the identification and recommendation of new IT opportunities and business operations as it relates to application development. Formulates, contributes to, and directs task identification, work effort estimates, and work schedules for research, prototype, and proof-of-concept IT activities. Directs and participates in all aspects of development tasks including data management, application architecture and business architecture. Provides guidance to staff on...

Looking for a Manager within Information Security for this fully remote position. Candidates should have experience managing a Threat Intelligence Program using Open Source Intelligence, Security Tools, Threat Intelligence Platforms, and Subscription Services, in a large enterprise environment. Candidates should have 7+ years of IT experience and 3+ years of information security experience. The role would also provide leadership actionable threat intelligence and serve as a subject matter expert. Will be responsible for building out and owning the Threat Intelligence Program, such as socialization of the program, Threat Intelligence Governance, Prioritization of tactical intel & threat hunting, and vulnerability disclosure. This position will ensure that we have the skills and capabilities required to deliver on our business and technical commitments. Will focus on Continuous improvement within the area and lead IT initiatives and special projects within their portfolio of...

Interested in fully remote opportunity as a Lead IT Analyst while working for an innovative healthcare company where you can have an impact on people's lives? Apply today and come join us at Magellan Health as we lead the world toward a healthier future! Looking for a Business Systems Analyst with: -  Meticulous attention to detail; the ability to juggle many tasks in parallel while delivering high quality results -  Someone who can work and collaborate with Software Engineers to understand features and technical implementation and ensure highest quality product delivery - Someone who can drive the software development process toward quality-centric methodologies - Experience in working in a team environment to support managed care vendors to implement solutions for pharmacy Claims Processing, Provider Operation Management, Member Management, and other Pharmacy benefit management Subject areas. - At least 5+ years of experience in analyzing various NCPDP transactions, 3 +...

Looking for a Manager within Information Security that has experience managing an Incident Response team using Splunk in a large enterprise environment. This role would also provide leadership and serve as a technical lead on incident events and incidents. Will be responsible for building out and owning the Security Incident Response Components, such as vulnerability disclosure. This position will ensure that we have the skills and capabilities required to deliver on our business and technical commitments. Will focus on Continuous improvement within the area and lead IT initiatives and special projects within their portfolio of applications. Manage 24x7x365 days of staff coverage Promotes a positive security culture for the organization by protecting the confidentiality, integrity, and availability of data and assets while assisting the company to successfully meet its strategic goals. Manages a team of Information Security Engineers and/or Analysts and is accountable for this...

Interested in a fully remote Sr. Software Engineer opportunity with a Fortune 500 healthcare company that's making a difference in the world? Consider joining us as at Magellan Health!  We're looking for a Software Engineer with web portal development experience and content management tool expertise. You will be working with React, JavaScript, and AWS.   This position services as an expert technical and industry resource to management, clients and development staff in new uses of information technology in all phases of major system and subsystem development. Provides consultation on internal and industry IT technical and business domain process capabilities including leadership in the identification and recommendation of new IT opportunities and business operations as it relates to application development. Formulates, contributes to, and directs task identification, work effort estimates, and work schedules for research, prototype, and proof-of-concept IT activities. Directs...