• Prior Authorization UM…

    Humana (Little Rock, AR)
    …a part of our caring community and help us put health first** The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ... and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support the...or more years of experience with Utilization Review and/or Prior Authorization + 1 or more years… more
    Humana (07/31/25)
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  • Telephonic UM Administration…

    Humana (Columbia, SC)
    …part of our caring community and help us put health first** The Telephonic - UM Administration Coordinator / UM Administration Coordinator 2 provides ... most appropriate treatment, care or services for members. Telephonic UM Coordinator/ UM Administration Coordinator...+ Member service + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care… more
    Humana (07/30/25)
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  • UM Administration Coordinator

    Humana (Schaumburg, IL)
    …help us put health first** Humana Gold Plus Integrated is seeking a UM Administration Coordinator who typically focuses on interpretation of department policy ... but has some latitude over prioritization and timing. The UM Administration Coordinator contributes to the ...and/or ICD-10 codes. + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care… more
    Humana (07/29/25)
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  • UM Administration Coordinator 2

    CenterWell (Tallahassee, FL)
    …a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. ... support assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non-clinical support for… more
    CenterWell (07/26/25)
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  • Director Utilization Management

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …clinical background within a managed care setting including a high-level understanding of prior authorization process from beginning of ingestion at Intake level ... About The Role The Director, Utilization Management ( UM ) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from… more
    Brighton Health Plan Solutions, LLC (07/18/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Baton Rouge, LA)
    …4 hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate, ... UM (utilization management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience… more
    CVS Health (07/30/25)
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  • Sr Analyst, Scope Management

    Evolent (Lansing, MI)
    …Association (AMA), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and various prior authorization lists, facilitating ... and informatics professionals who work with national health plans to ensure that prior authorization and financial coding stay accurate, compliant, and aligned… more
    Evolent (07/18/25)
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  • Manager, Medical Policy

    Commonwealth Care Alliance (Boston, MA)
    …the process for evaluating the effectiveness of company medical policies and prior authorization programs and supports the evaluation of payment policies. ... The Manager, Medical Policy reports to the Director of UM , and manages the personnel and work of the...evaluation of the effectiveness of company medical policies and prior authorization program. + Support the payment… more
    Commonwealth Care Alliance (05/31/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Tallahassee, FL)
    …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient Clinical ... operation and work schedule may include weekends, holidays, and evening hours._ ** UM Nurse Consultant** Fully Remote- WFH **Position Summary** + Utilizes clinical… more
    CVS Health (07/30/25)
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  • Physician Advisor - Allegheny Health Network

    Highmark Health (Pittsburgh, PA)
    …of illness, intensity of service, and the appropriateness of the setting for the administration of that care. The Physician Advisor is responsible for level of care ... with the hospital's interdisciplinary care team including Physicians, Case Managers, UM nurses, and the hospital leadership team. The Physician Advisor is… more
    Highmark Health (06/19/25)
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