• Clinical Pharmacy Specialist, Pharmacy Benefits…

    Northwell Health (New Hyde Park, NY)
    …for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy ... plans + Experience in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development + Experience with benefit… more
    Northwell Health (12/23/25)
    - Related Jobs

  • RN Case Manager - Care Coordination - Full time 8…

    University of Southern California (Arcadia, CA)
    …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... follows up to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates patient cares… more
    University of Southern California (11/19/25)
    - Related Jobs

  • UM Prior Authorization Review Nurse - RN

    UCLA Health (Los Angeles, CA)
    Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... + A minimum of three years of experience in utilization management , preferred + Team leading or...+ Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of… more
    UCLA Health (01/01/26)
    - Related Jobs

  • Primary Therapist - Full Time

    Penn Medicine (North Brunswick, NJ)
    …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more
    Penn Medicine (12/13/25)
    - Related Jobs

  • Primary Therapist - Per Diem

    Penn Medicine (Hamilton, NJ)
    …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... treatment, treatment plan development and coordination, referent relations, discharge planning, utilization management with insurance companies, and case … more
    Penn Medicine (11/06/25)
    - Related Jobs

  • Physician Advisor

    MaineGeneral Health (Augusta, ME)
    Job Summary:Provides clinical leadership and strategic support in utilization management (UM) and clinical documentation improvement (CDI), ensuring regulatory ... the individual will: + Provide clinical leadership and strategic support in utilization management (UM) and clinical documentation improvement (CDI), ensuring… more
    MaineGeneral Health (10/21/25)
    - Related Jobs

  • RN Care Manager - Care Management

    UNC Health Care (Smithfield, NC)
    …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... discharge plan. Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per… more
    UNC Health Care (12/23/25)
    - Related Jobs

  • Strategic Pharmacy Analyst

    RxBenefits (Charlotte, NC)
    …channel management , B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...closed won groups into a client record for Account Management (AM) and Implementation including the initial gathering of… more
    RxBenefits (12/04/25)
    - Related Jobs

  • Field Medical Director- (MD/DO)

    Evolent (Lansing, MI)
    …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (12/26/25)
    - Related Jobs

  • Field Medical Director, Oncology

    Evolent (Helena, MT)
    …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
    Evolent (11/27/25)
    - Related Jobs