• Medical Director-Geriatrician Specialty Strongly…

    Elevance Health (Indianapolis, IN)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... and overseeing clinical/non-clinical activities. Will also be responsible for utilization review/management. May be responsible for developing and implementing… more
    Elevance Health (10/30/25)
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  • Registered Nurse - Managed Care

    US Tech Solutions (Columbia, SC)
    …to this and will be reviewed with Management + Skill sets: Appeals and reconsideration experience, Utilization management experience, Prior experience working ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). +… more
    US Tech Solutions (10/29/25)
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  • Chief Psychiatrist - Behavioral Health Medical…

    Humana (Indianapolis, IN)
    …implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults ... strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and value-based payment programs. The… more
    Humana (10/23/25)
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  • Provider Relationship Account Consultant

    Elevance Health (AZ)
    …+ Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners. + ... on such issues as administrative and medical policy, reimbursement, and provider utilization patterns. + Conducts routine outreach to support the understanding of… more
    Elevance Health (10/23/25)
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  • Behavioral Health Medical Director- Child…

    Elevance Health (Walnut Creek, CA)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres to medical policies and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (10/22/25)
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  • Psychologist Reviewer - North Carolina

    Elevance Health (Norfolk, VA)
    …staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines ... within scope of license. + Conducts pre-certification, concurrent review, and appeals of Behavioral Health OP services. + Mentors Behavioral Health Care Management… more
    Elevance Health (10/22/25)
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  • Managed Care Pharmacy Resident

    Elevance Health (Winston Salem, NC)
    …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an impact:** + ... monographs, and formulary recommendations. + Develop strategies to drive formulary utilization and optimization. + Collaborate with account management teams to… more
    Elevance Health (10/20/25)
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  • Provider Relationship Account Consultant

    Elevance Health (Wichita, KS)
    …+ Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners + ... on such issues as administrative and medical policy, reimbursement, and provider utilization patterns + Conducts routine outreach to support the understanding of… more
    Elevance Health (10/04/25)
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  • CIC Registered Nurse - Hybrid

    Commonwealth Care Alliance (Boston, MA)
    …the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management, and closing quality ... across various locations. This position reports to the CIC APC Clinical Manager . **Supervision Exercised:** No, this position does not have direct reports.… more
    Commonwealth Care Alliance (10/02/25)
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  • Vice Chancellor for Enrollment Management…

    University of Colorado (Colorado Springs, CO)
    …of Operations. The position also maintains a dotted-line relationship with the Business Manager for Division Finances and HR and the Director of Auxiliary Finance. + ... + Ensure alignment of business operations, auxiliary facilities space utilization , auxiliary growth opportunities, and student-focused service delivery. (20%)… more
    University of Colorado (09/18/25)
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