• Utilization Management…

    Humana (Dover, DE)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (01/10/26)
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  • Coordinator, Intake Utilization…

    Evolent (Dover, DE)
    …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
    Evolent (01/06/26)
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  • Pharmacist - Utilization Management…

    Highmark Health (Dover, DE)
    …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (12/30/25)
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  • Healthcare Management Services (HCMS)…

    Elevance Health (Wilmington, DE)
    …Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity. ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member... management . + Partners with Provider Relations, Quality Management , Health Promotions, and Community Relations to… more
    Elevance Health (01/09/26)
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  • Lead Technical Analyst - Technical Product Manager

    Highmark Health (Dover, DE)
    …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (12/02/25)
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  • Medical Director, Medical Management

    Highmark Health (Dover, DE)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
    Highmark Health (11/21/25)
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  • Lead Clinical and Population Health Analyst…

    Highmark Health (Dover, DE)
    …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more
    Highmark Health (12/31/25)
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  • Pharmacist - Case and Disease Management…

    Highmark Health (Dover, DE)
    …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (01/10/26)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Dover, DE)
    …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
    Highmark Health (01/10/26)
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  • Senior Decision Support Consultant

    Highmark Health (Dover, DE)
    …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
    Highmark Health (11/14/25)
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