• Manager Clinical Pharmacy Operations…

    Highmark Health (Harrisburg, PA)
    …strategies and other pharmacy strategy teams to execute on the formulary/utilization ( UM ) and other strategic pharmacy products. This job will be responsible for ... utilization across both the pharmacy as well as the medical benefits. This job will have a strong compliance...relates to the operations of the Organization's formularies and UM processes such as prior authorizations, exceptions, and other… more
    Highmark Health (06/26/25)
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  • Pharmacy Operations Clinical Pharmacist…

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …support to internal partners including but not limited to Member Service , Medicare Operations, Compliance, Legal, Medical Directors, Sales/Marketing/Product and ... true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day...clinical staff in the day to day clinical operational UM activities to ensure that all Commercial (Pharmacy and… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Supv Regional Care Mgmt- Integrated Care Mgmt…

    Sharp HealthCare (San Diego, CA)
    … medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory ... management departments. Participates in the development of the annual UM plan and implementation of corrective action plans related...and implements new programs under the direction of the manager of in-patient care management and the Director of… more
    Sharp HealthCare (07/09/25)
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  • Supervisor, Utilization Management RN

    LA Care Health Plan (Los Angeles, CA)
    …to the needs of LA Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day operations of the UM… more
    LA Care Health Plan (07/08/25)
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  • Supply Chain Services Applications…

    University of Michigan (Ann Arbor, MI)
    Supply Chain Services Applications and Analytics Solutions Manager Apply Now **How to Apply** A cover letter is required for consideration for this position and ... employer. **Job Detail** **Job Opening ID** 266791 **Working Title** Supply Chain Services Applications and Analytics Solutions Manager **Job Title** App Sys… more
    University of Michigan (07/31/25)
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  • Manager Utilization Management

    Beth Israel Lahey Health (Burlington, MA)
    …making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for determining appropriate ... regulatory and reimbursement requirements of various commercial and government payers. Manages UM department in the context of other Revenue Cycle functions such as… more
    Beth Israel Lahey Health (06/06/25)
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  • Manager , Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care ... services , procedures, and facilities under the provisions of CCA's...facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing… more
    Commonwealth Care Alliance (05/21/25)
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  • Sr. Manager , Programs

    University of Miami (Miami, FL)
    …Department of Public Health Sciences is currently seeking a full time Sr. Manager , Programs. The Senior Manager , Programs oversees the day-to-day administrative ... University faculty and staff and other key stakeholders. Furthermore, the Senior Manager , Programs serves as the liaison to leadership, faculty, students, and staff.… more
    University of Miami (07/29/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    Overview Catholic Health is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, ... three nursing homes, a home health service , hospice and a network of physician practices across...Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according… more
    Catholic Health Services (07/24/25)
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  • Utilization Review Case Manager

    Covenant Health (Nashua, NH)
    Summary Conducts medical necessity reviews in accordance with the Utilization Management ( UM ) plan for patients that are housed on a nursing unit, to include ... Inpatient admissions, patients receiving Observation services and Outpatients in a Bed. Identifies delays in care. Documents and communicates findings with the care… more
    Covenant Health (07/30/25)
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