• Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * Demonstrated ability… more
    Commonwealth Care Alliance (05/21/25)
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  • Senior Medical Director, Network Performance

    Banner Health (Phoenix, AZ)
    …for our wholly owned and delegated plans in the areas of prior authorization , census management, prospective/concurrent/retro review, and appeals. Care ... require applicable certifications and/or licensures, including but not limited to: RN ; MD or DO; Driver's License; Certified Healthcare Protection Administrator… more
    Banner Health (07/24/25)
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  • Family Medicine Physician

    Baylor Scott & White Health (Johnson City, TX)
    …approaches** to reduce provider burden: + **RX Workgroup** (handles refill and prior authorization requests) + ** RN Case Management** (continuity ... for note-writing, starting June 2025) + **EConsults** (formal "curbside" specialist consultations) + **Pharmacy consults** for medication selection and formulary… more
    Baylor Scott & White Health (06/25/25)
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