• Utilization Management Nurse…

    CVS Health (Olympia, WA)
    …state of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
    CVS Health (05/04/25)
    - Related Jobs

  • Medical Director, Behavioral Health Services…

    Centene Corporation (Olympia, WA)
    …health programs such as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Serve as the ... as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Analyze data related to behavioral… more
    Centene Corporation (05/04/25)
    - Related Jobs

  • Care Review Clinician, Prior…

    Molina Healthcare (Seattle, WA)
    …standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
    Molina Healthcare (04/11/25)
    - Related Jobs

  • Coordinator, Utilization Management

    Evolent (Olympia, WA)
    …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... processing prior authorization requests in accordance with departmental...client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager,… more
    Evolent (05/03/25)
    - Related Jobs

  • Pharmacist, Utilization Mgmt (CA & WA)

    Molina Healthcare (Vancouver, WA)
    …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... selected for this position must be licensed in both states.** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all… more
    Molina Healthcare (05/02/25)
    - Related Jobs

  • VP, Healthcare Services in Georgia

    Molina Healthcare (Everett, WA)
    … of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior - authorization , inpatient review) and ... Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care… more
    Molina Healthcare (04/20/25)
    - Related Jobs

  • RN, Care Manager

    Whidbey General Hospital (Coupeville, WA)
    …anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management / Utilization Plan that integrates the functions of utilization review, ... in the areas of utilization review, status determination, clinical resource utilization , the discharge planning and appeal/denial management . The RN - Care… more
    Whidbey General Hospital (03/20/25)
    - Related Jobs

  • Pharmacy Technician

    Molina Healthcare (Bellevue, WA)
    …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...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
    Molina Healthcare (04/30/25)
    - Related Jobs

  • Senior Analyst, Healthcare Analytics Consultant

    Evolent (Olympia, WA)
    …teams and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and ... insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman).… more
    Evolent (05/03/25)
    - Related Jobs

  • Care Review Clinician, PA (RN) - Transplant Team…

    Molina Healthcare (Seattle, WA)
    …United States who has a compact, multi-state license. This team reviews the prior authorization requests for transplants; the ideal candidate will have ... experience either in utilization review or case management for transplants....and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility… more
    Molina Healthcare (04/11/25)
    - Related Jobs