• UM Case Manager

    Healthfirst (TX)
    …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... This position is 100% Remote** **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
    Healthfirst (10/07/25)
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  • Pharmacist, Utilization Management ( UM…

    Molina Healthcare (Dallas, TX)
    …medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and ... in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a...changes for the upcoming year. + Works with the Case Management department as part of a member-centered interdisciplinary… more
    Molina Healthcare (09/25/25)
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  • Behavioral Health Care Manager II

    Elevance Health (Grand Prairie, TX)
    …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to… more
    Elevance Health (09/26/25)
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