Community Health Options

Director Provider Network and Operations

Bachelor's degree required; master's degree desirable. Minimum 5 years of management experience and at least 5 years in provider contracting/relations. Knowledge of Medicare, RBRVS, case rate, capitation, and related payment structures.

Manager, Quality & Accreditation

Bachelor's degree; 5+ years health plan quality, accreditation experience; NCQA/URAC/HEDIS/CAHPS knowledge; strong analytics, reporting, and cross-functional collaboration.

Clinical Specialist, Utilization Management

Provides clinical decision support and utilization management; RN license in Maine (or Compact), 2+ years in Utilization Management; knowledge of MCG guidelines.

Clinical/Behavioral Health Specialist, Utilization Management

Clinical/Behavioral Health Specialist

RN or LPN with 1 year Utilization Management experience; 2 years behavioral health clinical experience; Maine RN/LPN license; English proficiency; knowledge of MCG Guidelines.

Director of Care Management, Utilization Management & Appeals

Director of Care Management

Oversee care management, utilization management, and appeals; lead strategic programs; ensure regulatory compliance.

Supervisor, Case Management

3-5 years case management, CCM designation, bachelor's preferred, Maine RN license or Compact, leadership experience.

Clinical Specialist Utilization Management, Outpatient

2+ years in Utilization Management; Maine RN license (or compact state); experience with MCG Guidelines; Bachelor's degree preferred.

Policy and Coding Research Specialist

3+ years in health plan policy research; 2+ years policy development; RN licensure; certified coder or near-hire; 3+ years in health plan setting; familiarity with ICD-10/11, CPT, HCPCS; MS Office.

Title	Location	Date
Director Provider Network and Operations Full Time · 5+ YOE Maine, United States · Remote	Maine, United States Remote	Apr 29, 2026
Manager, Quality & Accreditation Full Time · 5+ YOE United States · Remote	United States Remote	Apr 20, 2026
Clinical Specialist, Utilization Management Full Time · 2+ YOE United States · Remote	United States Remote	Mar 4, 2026
Clinical/Behavioral Health Specialist, Utilization Management Full Time · 1+ YOE United States · Remote	United States Remote	Jan 16, 2026
Director of Care Management, Utilization Management & Appeals Full Time · 3+ YOE Maine, United States · Remote	Maine, United States Remote	Dec 22, 2025
Supervisor, Case Management Full Time · 3+ YOE Maine, United States · Remote	Maine, United States Remote	Dec 18, 2025
Clinical Specialist Utilization Management, Outpatient Full Time · 2+ YOE United States · Remote	United States Remote	Dec 10, 2025
Policy and Coding Research Specialist Full Time · 3+ YOE Maine, United States · Remote	Maine, United States Remote	Dec 3, 2025

Activities	Health insurance plansMedical case managementUtilization managementMember servicesPharmacy benefit management
Headquarters	US
Industries	Health Insurance
Name	Community Health Options
Employees	214
Type	Non-Profit
Tagline	Provides member-led nonprofit health insurance plans in Maine.
Founded	2,011
Website	healthoptions.org

Community Health Options

About Community Health Options