- UTMB Health (Webster, TX)
- …system data entry of information such as referral requests, drug utilization management information, prepacking information, drug purchasing information, or ... Technologist assists Pharmacists in providing drug distribution, technical services, and clinical services associated with the preparation, storage and dispensing of… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- US Tech Solutions (Canton, MA)
- …**Job Descriptions** + Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... experience as a Prior Authorisation Pharmacist in a managed care setting + Utilization Management experience is required. **Education:** + Degree in Pharmacy or… more
- Point32Health (MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist is responsible for ... authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... staff, members and providers. + Provides backup for the Supervisor , whenever necessary. Participates in the orientation of new...Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management … more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Saint Francis Health System (OK)
- …placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the ... not all inclusive nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location: Virtual Office, Oklahoma 73105… more
- Covenant Health Inc. (Knoxville, TN)
- …audits thus promoting a culture of professional expertise in utilization management . + Provides monitoring and oversight of non- clinical utilization ... Overview Registered Nurse Utilization Management Full Time, 80 Hours...and written communication skills in order to clearly present clinical and financial data to various audiences as necessary.… more
- AmeriHealth Caritas (LA)
- …Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... reviews. Using clinical knowledge and experience, the clinician reviews provider requests...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care… more
- Point32Health (Canton, MA)
- …Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Per Diem Clinical Pharmacist is responsible for reviewing, processing and ... of or experience with Medicare Part B & D, Medicaid, and Drug Utilization Management . Prior authorization experience, including reviewing drug use criteria for… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- University of Rochester (Rochester, NY)
- …Staff Pharmacist - Clinical Responsibilities_** + In coordination with the clinical pharmacy team, oversees the management of drug shortages in the ... conduct the business of the functional unit under their supervision and management . Their supervisor should be aware of all ongoing interdepartmental… more
- BayCare Health System (Tampa, FL)
- …built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities ... + Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St Josephs | Clinical |… more
- WMCHealth (Valhalla, NY)
- Supervisor Of Nursing - Clinical Care Management Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management ... Details: N4 Supervisor of Nursing/Nurse Manager - Clinical Care Management Internal Posting: 12/03/25 to...the procedures specified in the Clinical Care Management Department through review of the Utilization … more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title:** **Social Worker - Emergency Dept (High Utilization )** **_Social Work Services at the Mount Sinai Hospital_** The Mount Sinai ... repeat ED visits and limited access to community-based care. + Excellent clinical skills, with exceptional skills in rapid psychosocial assessment and focused… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- … clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of medical ... Under the direction of the Case Management Coordinator, coordinates, negotiates, procures and manages the care of patients to facilitate achievement of positive … more
- University of Southern California (Arcadia, CA)
- …of the RN staff, and assists the Director and/or Manager with the operational management of the nursing unit. The Supervisor coordinates care of the patients ... of resources so that patient outcomes are optimized. The Supervisor serves as a professional clinical role...operations of assigned areas (budget, regulatory compliance, and resource utilization ). + Demonstrates clinical performance in the… more
- Children's Home Healthcare (Albuquerque, NM)
- …A VALID RN LICENSE* Children's Home Healthcare is now hiring for a RN Clinical Supervisor /Case Manager! Children's HH is the premier leader in Pediatric Home ... this growing professional team! We are seeking an experienced Clinical Supervisor in the Albuquerque area. The...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Boston University (Boston, MA)
- **FLOATING CLINICAL CARE SUPERVISOR , School of Dental Medicine, Clinical Affairs** **Job Description** **FLOATING CLINICAL CARE SUPERVISOR , School of ... compensation at the time of posting. **Position Type** Full-Time/Regular The Floating Clinical Care Supervisor is responsible to manage, provide guidance and… more
- Cedars-Sinai (Beverly Hills, CA)
- …or serves as a liaison, for administrative support activities including facilities management , pharmacy, utilization management , quality management , ... Little More About What You Will be Doing The Supervisor of Clinical Operations RN supports the...guidelines. + Works in a collaborative role with the management team, staff, and physicians in the clinical… more
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