• Clinical Appeals Coordinator

    Centene Corporation (Salem, OR)
    …is strongly preferred Must have a current RN or LPN** **Oregon state license ** Utilization review , case management, and appeals experience in a managed care ... years of clinical nursing or case management experience. Managed care or utilization review experience preferred. **License/Certification:** LPN, LVN, or RN… more
    Centene Corporation (10/17/25)
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  • Occupancy Planner

    T. Rowe Price (Baltimore, MD)
    …real estate and workplace strategies; managing occupancy planning and space utilization , and preparing space solutions and recommendations that meet stakeholder ... anticipate future space needs to inform opportunities for better utilization . Prepare and maintain accurate occupancy reports using CAFM...day per week from home. Base Salary Ranges Please review the job posting for the location of this… more
    T. Rowe Price (09/09/25)
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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 (09/26/25)
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  • Assistant Medical Director

    Medical Mutual of Ohio (OH)
    …to achieve goals.** **Responsibilities:** + Provides clinical expertise to the utilization review process and determinations. + Provides pre-determination ... principles. + Knowledge of health plan claims adjudication and utilization review processes preferred. Medical Mutual is...keyboard, mouse and headset. + Whether you are working remote or in the office, employees have access to… more
    Medical Mutual of Ohio (10/02/25)
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  • Senior Manager, Clinical Pharmacy Operations

    Centene Corporation (Indianapolis, IN)
    …clinical pharmacy to analyze and develop Clinical Programs and Drug Utilization Review across Centene Pharmacy Solutions. Responsible for day-to-day ... but not limited to clinical quality assurance programs, formulary management, drug utilization review , compliance and/or education. + Coordinate clinical efforts… more
    Centene Corporation (10/05/25)
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  • Pharmacy Director - Aetna Better Health…

    CVS Health (Frankfort, KY)
    …claims processing, contractual oversight, formulary management and updates, medication utilization review , prior authorization processes in alignment with ... heart, each and every day. **This is a fully remote , work from home role. The ideal candidate will...state meetings regarding pharmacy program initiatives, new legislation, Drug Utilization Review (DUR) and formulary/guideline changes. +… more
    CVS Health (10/15/25)
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  • Physician Advisor Clinical Appeals

    CommonSpirit Health (Englewood, CO)
    **Job Summary and Responsibilities** **This is a remote position.** **This position represents 1 of 2 available opportunities.** We are seeking a highly skilled ... tracking tools. The successful candidate will also collaborate cross-functionally with Utilization Management, CDI, coding, and compliance teams to reduce inpatient… more
    CommonSpirit Health (09/28/25)
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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 (09/08/25)
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  • Clinical Assistant

    BlueCross BlueShield of Tennessee (Chattanooga, TN)
    The BlueCare Utilization Management is excited to expand our team with a **Clinical Assistant\.** In this position, you will be responsible for handling incoming ... 1\+ years of Customer Service and Claims experience + Non\- Clinical Utilization Management experience + Facets, Care Advance experience and Agent Workspace… more
    BlueCross BlueShield of Tennessee (10/21/25)
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  • RN Case Manager - OLGMC - full time

    Ochsner Health (Lafayette, LA)
    …3 years of hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license ... of the conditions of participation as it relates to utilization review and discharge planning. + Maintains...determine whether the position you are interested in is remote or on-site._** _Individuals who reside in and will… more
    Ochsner Health (10/10/25)
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