• Pharmacist, Utilization Management (UM) Remote

    Molina Healthcare (Kenosha, WI)
    …The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will ... expert. + Ensures Molina is compliant with the coverage determination and appeals process. + Contributes to projects aimed at improving Star ratings, HEDIS,… more
    Molina Healthcare (10/16/25)
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  • Medical Director, Behavioral Health (NE)

    Molina Healthcare (Green Bay, WI)
    …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... * Provides second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance. * Implements… more
    Molina Healthcare (10/23/25)
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  • Senior Underwriter, Individual Disability

    Guardian Life (Madison, WI)
    …risks, consistently using the global approach (a "broadened view" of the entire case to forecast all needs and requirements at onset) to underwriting. + Proficiently ... evaluate more complex medical, financial, non-medical information with little to no manager involvement, and review prior files as developed, to determine the risk… more
    Guardian Life (10/30/25)
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  • Medical Director-PSCCR

    Elevance Health (Waukesha, WI)
    …with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
    Elevance Health (11/05/25)
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  • LTSS Service Coordinator

    Elevance Health (Sparta, WI)
    **LTSS Service Coordinator ( Case Manager )** **Hiring near Southwestern Wisconsin in counties:** Pepin, Buffalo, Trempealeau, Jackson, Clark, La Crosse, Monroe, ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
    Elevance Health (10/23/25)
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  • Plan Performance Medical Director

    Elevance Health (Waukesha, WI)
    …with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... the United States when conducting utilization review or an appeals consideration and cannot be located on a US...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (10/25/25)
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