• Care Review Clinician (BH Licensed)

    Molina Healthcare (Louisville, KY)
    …who must be licensed in KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... weekend day required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. JOB… more
    Molina Healthcare (11/09/25)
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  • Senior Manager, Medical Affairs Technology…

    Gilead Sciences, Inc. (Foster City, CA)
    …change over time, our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include but are not ... + Hands on experience administering and deploying platforms for Material Review (Veeva MedInquiry, VeevaVault, MedDocs) preferred. + Additional certifications in… more
    Gilead Sciences, Inc. (10/07/25)
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  • Care Manager PreService & Retrospective - Autism

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... of Minnesota Position Title: Care Manager PreService & Retrospective - Autism Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of… more
    Blue Cross and Blue Shield of Minnesota (12/18/25)
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  • Medical Director, Psychiatry (SafetyNet…

    Excellus BlueCross BlueShield (Buffalo, NY)
    … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization more
    Excellus BlueCross BlueShield (11/12/25)
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  • 340B Program Coordinator - Pharmacy - Full Time…

    John Muir Health (Walnut Creek, CA)
    …of the 340B program. Reports any deficiencies identified during auditing and review for appropriate resolution. + Ensures that the 340B pharmacy program is ... adequate systems checks are reviewed to prevent future billing issues. + Monitors utilization records and 340B purchasing accounts to ensure that software or tools… more
    John Muir Health (12/27/25)
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  • Strategic Pharmacy Analyst

    RxBenefits (Charlotte, NC)
    …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
    RxBenefits (12/04/25)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Englewood, CO)
    **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... system's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management and… more
    CommonSpirit Health (11/07/25)
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  • Clinical Denials Prevention & Appeals Specialist…

    Nuvance Health (Danbury, CT)
    …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to… more
    Nuvance Health (12/10/25)
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  • Registered Nurse RN Medical Management Services

    Banner Health (AZ)
    …a variety of career opportunities and innovative employment options by offering remote and hybrid work settings. The Registered Nurse RN Medical Management Services ... tool for contracted and noncontracted status,) and more. The RN Medical Management Services review Medicare Managed Care plans and receive case reviews via fax and a… more
    Banner Health (12/31/25)
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  • Supervisor, Support Administration

    Cuyahoga County Board of Developmental Disabilities (Cleveland, OH)
    …the Prior Authorization Review Process, implementation of AAI Administrative Review , and utilization of Medicaid State Plan Services. Deliver technical ... coaching and instruction to ensure skill acquisition, retention and utilization . Specifically provide oversight to ensure timely enrollment and redetermination… more
    Cuyahoga County Board of Developmental Disabilities (12/20/25)
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