• Utilization Management Administration…

    Humana (Concord, NH)
    …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
    Humana (10/10/25)
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  • Clinical Review Pharmacist (100%…

    Actalent (Oakland, CA)
    Clinical Review Pharmacist (100% Remote ) Seeking a dedicated and knowledgeable pharmacist to conduct drug utilization reviews and manage prior authorizations ... knowledge, and participate in on-call rotations. Responsibilities + Conduct drug utilization reviews. + Manage prior authorizations according to state and federal… more
    Actalent (10/15/25)
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  • Clinical Review Pharmacist - 100%…

    Actalent (Los Angeles, CA)
    Clinical Review Pharmacist 100% Remote | Contract-to-Hire | Benefits Options Job Description This role involves utilizing clinical skills to perform ... utilization management reviews, including prior authorizations, coverage exceptions, and...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
    Actalent (10/10/25)
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  • Care Review Processor ( Remote ) PST…

    Molina Healthcare (Vancouver, WA)
    JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... * Provides telephone, clerical and data entry support for the care review team. * Provides computer entries of authorization request/provider inquiries, such as… more
    Molina Healthcare (10/09/25)
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  • Remote Child Behavioral Medical Director

    Centene Corporation (Salem, OR)
    …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
    Centene Corporation (08/15/25)
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  • Medical Director - Sharp Health Plan - Hybrid…

    Sharp HealthCare (San Diego, CA)
    …selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective ... responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective rev1ew process.… more
    Sharp HealthCare (08/17/25)
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  • Remote Medical Director, Medicare

    Centene Corporation (Phoenix, AZ)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (10/17/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Helena, MT)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
    Evolent (08/29/25)
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  • Oncology Prior Authorization Case Manager, Non-RN…

    University of Miami (Miami, FL)
    …SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote . The incumbent conducts initial, ... concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare… more
    University of Miami (09/25/25)
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  • Prior Authorization, RN - Hybrid Remote

    Fallon Health (Worcester, MA)
    …of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations), focusing on selected complex medical and psychosocial ... functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with… more
    Fallon Health (10/02/25)
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