• Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health ... quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management and care… more
    DirectEmployers Association (10/02/25)
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  • Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
    DirectEmployers Association (10/02/25)
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  • Premera Blue Cross (Mountlake Terrace, WA)
    …an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their specialization in ... Oncology to provide benefit coverage determinations based on medical necessity and contract language for health plan members, including review of clinical documentation using medical policy criteria, guidelines, and member contracts. In addition, they will… more
    DirectEmployers Association (10/22/25)
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  • ERP International (Macdill AFB, FL)
    …is seeking a **Registered** **Nurse (RN)** for a Full-Time position in ** Utilization Management** at MacDill AFB, FL. Apply online today and discover more ... about this exceptional employment opportunity. www.erpinternational.com **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care… more
    DirectEmployers Association (09/18/25)
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  • ERP International (Vandenberg AFB, CA)
    **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management** for a temporary contract position in support of the30th ... Medical Group at Vandenberg AFB, CA (https://www.airforcemedicine.af.mil/MTF/Vandenberg/About-Us/) . **NOTE: This is NOT a Tele-Health/Remote Practice Opportunity.** **Be the Best!** Join our team of exceptional health care professionals across the nation.… more
    DirectEmployers Association (09/13/25)
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  • Lundbeck (Chicago, IL)
    …corporate guidelines. ESSENTIAL FUNCTIONS Engages in account portfolio planning using utilization data, and knowledge of therapeutic class management behavior by ... employed by MCO/PBMs and how they impact patients and physician's utilization Resourcefulness in getting access to decision makers, directly or indirectly,… more
    HireLifeScience (11/14/25)
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  • Dentons US LLP (Chicago, IL)
    …+ Gather requirements and translate them into data distribution and utilization needs; design databases meeting specifications addressing content management, content ... + Gather requirements and translate them into data distribution and utilization needs; design databases meeting specifications addressing content management, content… more
    DirectEmployers Association (09/20/25)
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  • Sun Pharmaceuticals, Inc (Chicago, IL)
    …directly to the Regional Sales Manager + Responsible for the understanding and utilization of sales reports, CRM, and forecasts + Responsible for timely call ... reporting tasks. + Responsible for managing Sales budgets within their territory + Responsible for meeting monthly, quarterly, and yearly sales goals **SUPERVISION RECEIVED** **:** Reports to Regional Sales Manager **INTERACTIONS WITH OTHERS:** Interacts at… more
    DirectEmployers Association (10/10/25)
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  • Stanford Health Care (Palo Alto, CA)
    …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
    DirectEmployers Association (11/11/25)
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  • Stanford Health Care (Palo Alto, CA)
    …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...records as required; collects, analyzes and reports ondata for utilization , quality improvement, compliance, and other areas as assigned.… more
    DirectEmployers Association (11/11/25)
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