- Humana (Providence, RI)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Providence, RI)
- …Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Highmark Health (Providence, RI)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Prime Therapeutics (Providence, RI)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Evolent (Providence, RI)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- US Tech Solutions (RI)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- Highmark Health (Providence, RI)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Providence, RI)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Parexel (Providence, RI)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more