• Utilization Management…

    CVS Health (Charleston, WV)
    …all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
    CVS Health (10/26/25)
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  • Utilization Management…

    CVS Health (Charleston, WV)
    …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
    CVS Health (10/26/25)
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  • Utilization Management Nurse…

    CVS Health (Charleston, WV)
    …(UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited to) + Reviews...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
    CVS Health (10/25/25)
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  • Clinical Lead- Market DON Consultant

    Genesis Healthcare (Follansbee, WV)
    …while making a meaningful impact in the communities we serve. Responsibilities The Clinical POD Leader Director of Nursing (DON) is responsible for overseeing the ... clinical aspects for the assigned POD, in addition to...strategic planning, budget preparation, and effective oversight of resource utilization . *Ensures the realization of high quality and cost-effective… more
    Genesis Healthcare (10/18/25)
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  • Medicare Advantage Quality Consultant

    Highmark Health (Charleston, WV)
    …set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected… more
    Highmark Health (09/22/25)
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  • Pharmacy Benefit Consultant

    Highmark Health (Charleston, WV)
    …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
    Highmark Health (08/26/25)
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