- Actalent (Omaha, NE)
- Now Hiring! Clinical Pharmacist - Fully remote ! Job Description MUST HAVE a Nebraska Pharmacy License. This position requires a dynamic pharmacist to be the expert ... The role involves designing, implementing, maintaining, and measuring pharmacy-related utilization management programs. This includes the development of workflows,… more
- ChenMed (Miami, FL)
- …experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare for ... our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other… more
- Molina Healthcare (Spokane, WA)
- The Clinical Services Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health ... manage work time wisely. Further details to be discussed during our interview process. Remote position in WA state. Work hours: Monday-Friday: 8:00AM - 5:00PM PST WA… more
- CareFirst (Baltimore, MD)
- …FUNCTIONS:** + Provide deep subject matter expertise in all areas of Utilization Management (UM), including pre-service, concurrent review , and inpatient ... goals. Support clear communication across vertical components of the business. Review and support task coordination while identifying potential process improvements… more
- Actalent (Sacramento, CA)
- …essential. Additional Skills & Qualifications 3+ year of recent experience required Utilization Review Strong Product and clinical pharmacy knowledge State ... Hiring Fully Remote Pharmacists! MUST have PharmD and state licensure...and state licensure Description This role involves conducting drug utilization reviews and managing prior authorizations in accordance with… more
- CBRE (Pierre, SD)
- Global Finance Director - Remote USA Job ID 233748 Posted 13-Aug-2025 Service line GWS Segment Role type Full-time Areas of Interest Accounting/Finance, ... Administrative, Data & Analytics, Project Management Location(s) Remote - US - Remote - US...special projects and prepares presentations for senior management. Facilitates review and approval of capex projects in accordance with… more
- Molina Healthcare (Yonkers, NY)
- …healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare ... utilization and cost containment reports and makes recommendations based...ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & care management functions of Martin's Point's Health Plans. The MD ... Health Plan members. + Assists in the construction of the annual Utilization Management, Care Management, and Disease Management Program Descriptions and works to… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... other members of the interdisciplinary care team to coordinate services, decrease utilization , and ensure optimal health outcomes. We are looking for an experienced… more
- Shuvel Digital (Lawrenceville, NJ)
- …to make corrections and ensures accuracy for the days work. + Researches all utilization review claims for accuracy prior to billing on a timely basis. ... Medical Biller Remote Summary: Ensures responsibility for all aspects of...changing departmental demands. Notes: + Officially open to 100% remote . Still prefer onsite/hybrid because of training, but they… more