• Case Management Social Worker…

    WellSpan Health (Chambersburg, PA)
    …data analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required, and ... neighbors with important health-related programs focused on disease prevention and management , early detection screening, and tools and resources to prevent disease… more
    WellSpan Health (01/01/26)
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  • UM Care Manager (RN) - PA Candidates Preferred

    UPMC (Pittsburgh, PA)
    Are you a registered nurse with a background in utilization management ? UPMC Health Plan is looking for you! We are hiring a full-time Utilization ... Management Care Manager to support the Utilization Management Clinical Operations Department. This position will predominantly work from home, standard… more
    UPMC (01/01/26)
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  • AVP, Medicare Medical Services

    UPMC (Pittsburgh, PA)
    …medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... policies of the Health Plan. Contributes to process improvement within the Utilization Management department. + Participates in activities to support policy… more
    UPMC (12/09/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Harrisburg, PA)
    …Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use… more
    Evolent (12/18/25)
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  • Field Medical Director, Cardiology

    Evolent (Harrisburg, PA)
    …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (12/31/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Harrisburg, PA)
    …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (10/10/25)
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  • Strategic Pharmacy Analyst

    RxBenefits (Philadelphia, PA)
    …channel management , B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...closed won groups into a client record for Account Management (AM) and Implementation including the initial gathering of… more
    RxBenefits (12/04/25)
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  • Contract Manager Corporate Supply Chain

    Penn Medicine (Philadelphia, PA)
    …ensure lowest price paid. + Works to identify opportunities for standardization and utilization management within a product categories and potential to leverage ... Contract Manager collects and conducts analysis of spend data and other utilization data to identify expense reduction and operational improvement opportunities as… more
    Penn Medicine (11/11/25)
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  • Senior Manager - Clinical Development (Pharmacist)

    CVS Health (Pittsburgh, PA)
    …will be responsible for overseeing the development, maintenance, and execution of utilization management programs. This will include both the clinical content ... needed to ensure the programs are implemented correctly. Knowledge of utilization management interventions including prior authorization, step therapy, quantity… more
    CVS Health (12/28/25)
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  • Field Medical Director- (MD/DO)

    Evolent (Harrisburg, PA)
    …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (12/26/25)
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