• Utilization Management Coordinator

    Integra Partners (Troy, MI)
    …(UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorizations and appeals. Rate ... claims platform + Verify all necessary documentation has been submitted with authorization requests + Contact requesting providers to obtain medical records or other… more
    Integra Partners (06/28/25)
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  • Pharmacist, Utilization Management…

    Molina Healthcare (Warren, MI)
    …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
    Molina Healthcare (07/19/25)
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  • Associate Manager - Duals Prior…

    CVS Health (Lansing, MI)
    …day. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development ... Registered Nurse + 3+ years of managed care experience + 1+ years of utilization management experience + Ability to travel up to 5% for meetings/audits + Must… more
    CVS Health (06/28/25)
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  • Supervisor, Clinical Pharmacy/MTM - Remote

    Molina Healthcare (Sterling Heights, MI)
    …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management / prior authorization services as needed. * Supervises the… more
    Molina Healthcare (07/09/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (MI)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
    Molina Healthcare (07/12/25)
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  • Sr Analyst, Scope Management

    Evolent (Lansing, MI)
    …Analyst, Scope Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent ... and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work...impactful manner. + Perform other duties related to the management of prior authorization and… more
    Evolent (07/18/25)
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  • Pharmacy Technician Remote (PST Hours)

    Molina Healthcare (Detroit, MI)
    …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... through Friday from 1230pm to 9pm MST. Molina Pharmacy Services/ Management staff work to ensure that Molina members have...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
    Molina Healthcare (07/20/25)
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  • Director, Physician Leadership - Medical Directors…

    Humana (Lansing, MI)
    …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
    Humana (07/18/25)
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  • Integrated Care Management Assistant Case…

    McLaren Health Care (Petoskey, MI)
    …service arrangements, processing, organizing and obtaining insurance verification and/or prior authorization from insurance companies for discharge arrangements. ... between patients, colleagues and community. 5. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
    McLaren Health Care (04/29/25)
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  • Formulary Operations Management…

    CenterWell (Lansing, MI)
    …Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a ... help facilitate clinical medication review decision making. + Responsible for operationalizing prior authorization criteria into Humana systems in alignment with… more
    CenterWell (07/19/25)
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