Utilization review nurse jobs in Holden, MA - 368 jobs

Focus Staff is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Springfield, Massachusetts. Job Description & Requirements Specialty: Labor and Delivery Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel We currently have a client in Springfield, MA looking for a Travel PP RN - Post Partum Registered Nurse! Focus Staff is seeking a traveling Postpartum RN to provide important physical and emotional care and recovery for both the new mom and the newborn baby following a delivery. Contract Assignment - 13 Weeks (Temporary) Shift: 3x12 Nights Rewards: (Postpartum RN Benefits) Pay depends on location and experience. Health Insurance Coverage 401K matching New licensing reimbursement Job staffing in all 50 states We are offering a very competitive package to the right Postpartum RN candidate. Candidates need to possess phenomenal efficiency and attention to detail with a strong knowledge of procedures and patient safety. Being Compassionate and sensitive is a prerequisite for the profession. The ideal Candidates goes a step further by being a critical thinker and fast to act with emergencies. Requirements: Motivated candidates who are looking for career growth AHA Current Basic Life Support certification for Health Care Providers BSN from accredited nursing program, and proper licensure Excellent communication skills with the staff, physicians, patients, and families Work Experience: At least 2 years of experience If you are seeking a Travel PP RN - Post Partum Registered Nurse position and would like to work with an agency that will listen to your needs and career goals, then Focus Staff is the right place to be. We are proud of our ability to build relationships with all our healthcare professionals, whether you are seeking Travel assignments, PRN work or Permanent Placed positions. Responsibilities: Assess and monitor the new mother after delivery to ensure proper recovery and healing, physically and emotionally Clean and monitor the newborn baby Check vital signs of mother and baby Check Caesarian incisions if applicable Remove catheters after delivery Dispense medication as needed Provide education to new parents regarding how to care for an infant Work with lactation consultants to help the new mother breastfeed All other responsibilities as needed Job Type: Contract/Temporary/Travel Location: Springfield, MA If You have a Passion for Postpartum Care, Apply Today and a Recruiter will guide you through the Process. Join our VIP team of Traveling Professionals! Travel Postpartum Registered Nurse - Postpartum RN -Traveling Postpartum Nurse - PP RN, Part-Time, Contract, Travel, Temporary, 13 Weeks, Temp. Tier5, Travel PP RN - Post Partum Registered Nurse Focus Staff Job ID #a0xVt00000DOXoBIAX. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel L&D RN - Labor & Delivery Registered Nurse About Focus Staff Your Journey, Our Focus. Travel Confidently, Care Boldly with Focus Staff. At Focus Staff, we're here to make your travel healthcare career rewarding, seamless, and stress-free. Whether you're a travel nurse, therapist, or allied health professional, we take care of the details so you can focus on what you do best - caring for others. Our mission is simple: to help healthcare heroes like you thrive, no matter where your journey takes you. With thousands of job opportunities across all 50 states, our dedicated recruiters work closely with you to match you to the right assignment, based on what matters most to you - pay, location, benefits, or career growth. From day one, you'll enjoy premium benefits like medical coverage that bridges between assignments, 401K matching, travel and licensing reimbursements, and personalized housing support. Plus, our team is here for you 24/7, with clinical support available whenever you need guidance or backup. At Focus Staff, we believe in making every assignment a smooth, comfortable, and empowering experience. Let's make your next adventure your best one yet.

Solomon Page is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Canton, Georgia. Job Description & Requirements Specialty: PACU - Post Anesthesia Care Discipline: RN 36 hours per week Shift: 12 hours, nights Employment Type: Travel Our client is looking to add a Registered Nurse to their team. Job Details: Location: Canton, Georgia Duration: 13 Weeks Start Date: Shift: 3x12 Nights Qualifications: Current Georgia license Excellent interpersonal skills including patience, empathy, and compassion Effective communication skills, including active listening, writing, speaking and reading comprehension Fast and adaptive problem-solving abilities Ability to stand for long periods of time If you meet the required qualifications and are interested in this role, please apply today. Why Work with Us The success of Solomon Page is defined by our people. Offering a comprehensive benefits package, travel nurses have immediate access to medical coverage and ReviveHealth virtual care. Additionally, you are offered access to dental and vision coverage, commuter benefits, a 401(k) plan, flexible spending, referral bonuses, ongoing training, and more. As an ESOP company, Solomon Page offers an employee stock ownership plan to all consultants. As a member of our traveler community, you will join a nurturing culture that fosters your career goals. Solomon Page can connect you with your next opportunity - whether it is in your hometown, or you are looking to travel to a new destination. About Solomon Page Healthcare & Medical Staffing Accredited by the Joint Commission with the Gold Seal of Approval, Solomon Page prides ourselves in developing long-term relationships with healthcare providers based on trust and respect. Our experienced Healthcare and Medical Staffing experts are committed to providing safe and quality patient care through our wide network of travel nurses, locum tenens, and allied resources. For more information and additional healthcare opportunities, visit: solomonpage.com and connect with Solomon Page on Instagram, Facebook, Twitter, LinkedIn, and TikTok. 414360 Solomon Page Job ID #414360. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: nurse - rn - labor and delivery / l&d | canton, georgia About Solomon Page Founded in 1990, Solomon Page has grown to be a leader in the staffing industry. As a member of our healthcare provider community, you will join a nurturing culture that fosters your career goals. We have the network and resources to connect you with your next opportunity - whether it is in your hometown, or you are looking to travel to a new destination. Accredited by the Joint Commission with the Gold Seal of Approval, Solomon Page prides itself in developing long-term relationships with healthcare providers based on trust and respect. Headquartered in New York with offices throughout the United States our experienced healthcare and medical staffing experts are committed to providing safe and quality patient care through our wide network of travel nurses, locum tenens, and allied resources. For more information and additional healthcare opportunities, visit: and connect with us on Facebook, Twitter, Instagram, Tik Tok, and LinkedIn. ReviveHealth Virtual Care: Available immediately. Receive free, 100% company paid, virtual care access. Upon commencement of your employment, Solomon Page offers automatic enrollment into ReviveHealth, which offers concierge, membership-based access to virtual primary care, urgent care, mental health therapy, a vision program, and prescription medications. Medical Coverage: Available immediately. Whether you are looking to enroll in single or family insurance, you have immediate access to quality coverage. Dental Coverage: Available the 1st of the month after your hire date. We offer dental insurance to you and your dependents. Vision Coverage: Available the 1st of the month after your hire date. We offer vision insurance to you and your dependents. Commuter Benefits: Available the 1st of the month after your hire date. Set aside pre-tax money to pay for public transportation. 401K Plan: Associates can enroll in the 401K plan after they have worked 1000 hours. ESOP Benefits: As an ESOP company, Solomon Page offers an employee stock ownership plan. Referral Bonus: A cash bonus is offered for referring a candidate to Solomon Page who gets placed. Training & Support: Training programs and ongoing career coaching and support is offered to consultants. Benefits Medical benefits Dental benefits Vision benefits 401k retirement plan Referral bonus

PRN Healthcare is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Canton, Georgia. Job Description & Requirements Specialty: PACU - Post Anesthesia Care Discipline: RN 36 hours per week Shift: 12 hours, nights Employment Type: Travel PRN Healthcare Job ID #. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: L&D RN About PRN Healthcare Our story starts with a 21-year-old CNA named Pete Hietpas. Pete was diligently working in eastern Wisconsin with a variety of staffing agencies, but something was missing. He loved caring for his patients, but felt that staffing agencies were exchanging compassion for competitiveness. He was determined to change that. As a result, he started Nurses PRN in 1995 to become a model for the healthcare staffing industry - being competitive in the marketplace, yet still maintaining a compassionate heart. Over the years Nurses PRN grew and evolved as a nationwide healthcare staffing company, and therefore wanted to be more inclusive to all valued healthcare professionals: nurses, allied health, locum tenens, CNAs, and more. This lead to the introduction of PRN Healthcare, which is inclusive of Nurses PRN and all of our other healthcare divisions. Our mission to create authentic, meaningful relationships with our healthcare professionals helps us set them up for success in their dream assignment, whether that be a travel contract, local contract, or per diem shift. This is all driven by the simple idea that better care for our healthcare workers, leads to better patient care - and this is all supported by a dedicated internal staff. Our company culture is strongly backed by faith-based values and activities, to remind us that our success provides us the opportunity to serve and give back to our communities. This is the spirit of caregiving. This is PRN Healthcare. Benefits Weekly pay Guaranteed Hours Continuing Education 401k retirement plan Referral bonus Employee assistance programs Company provided housing options Medical benefits Dental benefits Vision benefits Life insurance

Assured Nursing is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Canton, Georgia. Job Description & Requirements Specialty: PACU - Post Anesthesia Care Discipline: RN Start Date: Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Assured Nursing is currently seeking a RN for a contract position in Canton Georgia. This is a 7p-7:30a, 19:00:00-07:30:00, 12.00-3 position in the Nursing. The ideal candidate will possess a current state license as a RN and have at least 2 years of recent experience as a L&D RN. Assured Nursing Job ID #. Pay package is based on 12 hour shifts and 36.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:L&D,19:00:00-07:30:00 Benefits Weekly pay Holiday Pay 401k retirement plan Referral bonus Medical benefits Dental benefits Vision benefits

Triage Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Boston, Massachusetts. Job Description & Requirements Specialty: ICU - Intensive Care Unit Discipline: RN Start Date: Duration: 4 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Travel Nursing: Intensive Care Unit Boston Location: Boston Start Date: Shift Details: 12H Variable (12:00 AM-12:00 PM) 36 hours per week Length: 4 WEEKS Apply for specific facility details.ICU RN Triage Staffing Job ID #EQG4NA3D. Posted job title: Nursing: Intensive Care Unit About Triage Staffing At Triage, we prefer to be real. Real about expectations-both ours and yours. Real about how a decision you make today could affect your tomorrows. Real about how compensation actually works. Real about how great-or grating-your next supervisor may be. Being real allows everyone at Triage to be ready. Ready to serve you with real honesty. So if that gig near the ocean is really no day at the beach, or that third shift comes with a second-class rate, we tell you. So you can be ready, too. We staff all five major divisions of acute care-nursing, lab, radiology, cardiopulmonary and rehab therapy, offering: - Competitive, custom pay packages - One point of contact for both travelers and facilities (per division) - A reliable recruiter who's got your back throughout your entire assignment - In-house compliance and accounting specialists - A clinical liaison team available 24/7 to offer medical and professional support and career development - A mentoring program that is run and managed by actual clinicians-yeah, you read that right - And more (because of course there's more) Are we the biggest? No. Are we the best? That's rather subjective, but we're trying to be. Will we work like hell to get you as close to your idea of heaven as possible? Yes. Yes, we will. Benefits: Day One comprehensive, nationwide insurance plans for health, vision and dental and life-including a HSA option Day One 401(k) program with employer-matching contributions once eligible Facility cancelling protection-your time is money on and off-the-clock Guaranteed hours Weekly paychecks via direct deposit Earned vacation bonuses for time worked Paid holidays Employee assistance program (EAP)-your mental health is important, too Continuing education, certification and licensing reimbursement Workers comp-because accidents happen Top-rated professional liability insurance Company provided housing options Referral bonus-$750 in your pocket after they've completed a 13-week assignment

MedPro Healthcare Staffing is seeking a travel nurse RN Float Med Surg for a travel nursing job in Boston, Massachusetts. Job Description & Requirements Specialty: Med Surg Discipline: RN 36 hours per week Shift: 12 hours Employment Type: Travel MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is seeking a quality ICU/CCU Registered Nurse for a travel assignment with one of our top healthcare clients. Requirements Active RN License Degree from accredited nursing program BLS & ACLS Certification Eighteen months of recent experience in an Acute Care ICU setting Other requirements to be determined by our client facility Benefits Weekly pay and direct deposit Full coverage of all credentialing fees Private housing or housing allowance Group Health insurance for you and your family Company-paid life and disability insurance Travel reimbursement 401(k) matching Unlimited Referral Bonuses up to $1,000 Duties Responsibilities ICU/Critical Care Nurse (RN) possesses the skills needed to manage the care of adult patients experiencing life-threatening problems requiring complex assessment, high intensity therapies, and interventions. Provide patient care as well as education and support to the patient's family. Ensure proper functioning of life support equipment such as ventilators and feeding tubes. Observe the patient's heart rate, blood pressure and respiration for signs of distress. Administer medication, IVs, and insert catheters as needed. Meticulous documentation of medication administration. Assist in emergency nursing procedures necessary for prompt control of changes in patient's physical condition. Perform cardiopulmonary resuscitation accurately and effectively. About Agency MedPro Healthcare Staffing is a Joint Commission certified provider of contract staffing services. Since 1983, we have placed nursing and allied travelers in top healthcare facilities nationwide. Join us today for your very own MedPro Experience. If qualified and interested, please call for immediate consideration. MedPro Staffing is an Equal Opportunity Employer. All applicants will be considered for employment without attention to race, color, religion, national origin, age, sex, disability, marital status or veteran status. Key Words: Intensive Care Unit, Nurse, Registered Nurse, RN-ICU, Critical Care Unit, Critical Care Nurse, Intensive Care Nurse, RN-CCU, Travel Nurse, Agency Nurse, Contract Nurse, Travel Contract, ACLS, EKG, RN, Registered Nurse, ICU, CCU, RN-ICU, RN-CCU, MICU, SICU, Advanced Life Support, CPR, BLS, Travel Nursing *Weekly payment estimates are intended for informational purposes only and include a gross estimate of hourly wages and reimbursements for meal, incidental, and housing expenses. Your recruiter will confirm your eligibility and provide additional details. MedPro Job ID #a0Fcx000008dhlGEAQ. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: ICU/CCU Registered Nurse Nursing: ICU - Intensive Care. About MedPro Healthcare Staffing At MedPro Healthcare Staffing, we believe no one cares more for caregivers than we do. Our mission is simple: you focus on your patients, and we'll take care of the rest. As a Joint Commission-certified leader in temporary and contract healthcare staffing since 1983, MedPro has proudly connected nursing and allied travelers with top healthcare facilities across the nation. With thousands of job opportunities available nationwide, we make it easy to find assignments that align with your goals and lifestyle. Our on-staff clinical support team-alongside a compassionate group of experienced recruiters-provides hands-on guidance every step of the way. From Day 1 medical benefits and a 401(k) plan to personalized career support, we're committed to ensuring every professional we serve feels valued, cared for, and empowered to succeed. Guided by a CEO who is a Registered Nurse, MedPro is built on a foundation of clinical insight and genuine compassion for the caregiving community. Through The MedPro Experience, we deliver travel assignments that are rewarding, memorable, and designed to help you DREAM big, EXPLORE often, and ACHIEVE greatness. Benefits Day 1 medical, dental, and vision benefits for you and your family Weekly pay and direct deposit Unlimited Referral Bonuses starting at $500 On Staff Clinical Support Team Access to nationwide travel assignments MPX+ Mobile appreal-time access to jobs, credentials, assignment details, and more Full coverage of all credentialing fees Private housing or housing allowance Tax Free Per Diems, Housing Stipends and Travel Reimbursements Company-paid life and disability insurance Travel reimbursement 401(k) matching Benefits Weekly pay Referral bonus Employee assistance programs

GHR Healthcare - PH Division is seeking a travel nurse RN PACU - Post Anesthesia Care for a travel nursing job in Canton, Georgia. Job Description & Requirements Specialty: PACU - Post Anesthesia Care Discipline: RN Start Date: Duration: 12 weeks 36 hours per week Shift: 12 hours Employment Type: Travel Planet Healthcare Job ID #. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. About GHR Healthcare - PH Division For over 30 years, GHR Healthcare has been the bridge between healthcare professionals and the facilities that need them nationwide. We're committed to uncovering your ideal fit, supported by GHR's dedication to competitive compensation, transparent communication, and a devoted team that genuinely cares about your career journey. You can trust us to stand by your side as your advocate, confidante, and partner in advancing your career. At GHR, care and consideration are at the heart of everything we do. Visit ghrhealthcare.com to learn more.

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with Medicaid/MassHealth knowledge. Principal Duties and Responsibilities: • Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual , company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs • Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. • Manage incoming requests for procedures and services including patient medical records and related clinical information. • Strong working knowledge of commercial, self-insured, fully insured and limited network plans. • Adherence to program, departmental and organizational performance metrics including productivity. • Excellent verbal and written communication skills. • Excellent problem solving and customer service skills. • Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. • Must be self-directed and highly motivated with an ability to multi-task. • Develop and maintain effective working relationships with internal and external customers • Hold self and others accountable to meet commitments. • Sound decision-making and time management skills. • Proactive in areas of professional development, personally and for the department. • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. • Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. • Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual , Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse (RN) license required Experience At least 2-3 years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years of experience in a payer setting is highly preferred At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it's needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. This is a remote role with occasional onsite team meetings in Somerville, MA. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

**Full Time Dispensing Nurse - * LPN/LVN* *Health Care Resource Centers *is looking for a detail oriented and empathetic Licensed Practical Nurse / Licensed Vocational Nurse to dispense prescribed medications as part of a treatment team in partnership with Physicians and Nursing Supervisors. The dispensing nurse also shares responsibility of maintaining dispensing equipment, managing medication inventory and reporting patient treatment information. An ideal dispensing nurse candidate works cooperatively with supervisory counseling staff and demonstrates a non-judgmental and accepting attitude toward the Substance Use Disorder. *Responsibilities: * * Administer daily medication to patients in accordance with program policy and medical protocols. * * Use automated dispensing system(s), calibrate pump and maintain dispensing equipment * Produce and maintain appropriate records and reports as required by Company protocol, Federal and State Regulations * Ensure compliance with security standards for the distribution and storage of controlled substances as set forth in the Code of Federal regulations * Order, receive and stock medication in accordance with DEA and State regulations. (If granted Power of Attorney) * Provide daily assessment of patients * Assist Nursing Supervisor to orient new nursing staff * Other related duties as determined by supervisor *Qualifications: * * Current & good standing LPN/LVN license in the State of Massachusetts.* * Current CPR certification required. * EMR & computer proficiency desired. * Experience in chemical dependency preferred, self-motivated and directed, must have a positive attitude toward individuals in substance abuse treatment. * Satisfactory drug screen and criminal background check. *Salary Range: * Salary ranges from $28.00 to $29.00 an hour. The salary of the candidate(s) selected for this role will be set based on a variety of factors, including but not limited to, experience, education, specialty, and training.* *BayMark offers excellent benefits:* * 401K match * Medical, Dental, Vision Insurance * Voluntary Worksite Benefits (i.e., Accidental Injury) * Company paid Short & Long Term Disability * Company paid Basic Life Insurance * Paid Time Off * Bereavement Leave * Flexible Sick Time * Employee Referral Program * BayMark Perks Program * Jury Duty & Witness Duty Leave * BayMark University Learning * *Here is what you can expect from us:** *Health Care Resource Centers*, a progressive substance abuse treatment organization, is committed to the highest quality of patient care in a comfortable outpatient clinic setting. Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life. *Health Care Resource Centers* is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.**

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The Medicare UM Case Manager, RN performs utilization management activities primarily for Medicare Advantage, including review of authorizations for home care, high tech radiology, outpatient, inpatient, and post-acute services. The Medicare UMCM reviews the medical necessity of authorization requests using NCD, LCD, Medicare Benefit Policy Manual, medical policies, and InterQual criteria. Qualifications Education Associate's Degree Nursing required; Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse license required Basic Life Support [BLS Certification] Certification preferred Experience At least 2-3 years of utilization management strongly preferred Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Medicare Benefit Policy Manual preferred InterQual experience preferred Knowledge, Skills, and Abilities Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. Ability to establish strong rapport and relationships with patients and staff. Proficient in Microsoft Office and industry-related software programs. Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. Ability to maintain client and staff confidentiality. Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. Knowledge of Healthcare and Managed Care preferred. Additional Job Details (if applicable) Working Conditions This is a remote role that can be done from most US states Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with Medicaid/MassHealth knowledge. Principal Duties and Responsibilities: * Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual , company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs * Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. * Manage incoming requests for procedures and services including patient medical records and related clinical information. * Strong working knowledge of commercial, self-insured, fully insured and limited network plans. * Adherence to program, departmental and organizational performance metrics including productivity. * Excellent verbal and written communication skills. * Excellent problem solving and customer service skills. * Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. * Must be self-directed and highly motivated with an ability to multi-task. * Develop and maintain effective working relationships with internal and external customers * Hold self and others accountable to meet commitments. * Sound decision-making and time management skills. * Proactive in areas of professional development, personally and for the department. * Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. * Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. * Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual , Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education * Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials * Massachusetts Registered Nurse (RN) license required Experience * At least 2-3 years of utilization review experience is highly preferred * Experience using Interqual or Milliman is highly preferred * At least 1-2 years of experience in a payer setting is highly preferred * At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities * Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value * Strong aptitude for technology-based solutions. * Embrace opportunities to take the complexity out of how we work and what we deliver. * Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation * Current in healthcare trends. * Ability to inject energy, when and where it's needed. * Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. * Be accountable for delivering high-quality work. Act with a clear sense of ownership. * Bring fresh ideas forward by actively listening to and working with employees and the people we serve. * Communicate respectfully and professionally with colleagues * Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions * Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. * This is a remote role with occasional onsite team meetings in Somerville, MA. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Benefits: Direct Deposit Weekly Pay Competitive salary Inpatient RN - Utilization Review Nurse (Behavioral Health) - Cambridge, MA Schedule: Day Shift, Monday-Friday, 8:30 AM - 5:00 PM Pay: $72/hour Job Summary: We are seeking a skilled Inpatient RN Utilization Review Nurse to join our behavioral health team in Cambridge. This role focuses on acute care review and utilization management to ensure high-quality patient care. Requirements: Must be a local candidate within 50 miles of Cambridge, MA Acute care experience required Experience with InterQual criteria EMR experience required (EPIC preferred) Strong clinical judgment and utilization review skills Responsibilities: Review and evaluate patient care for appropriateness and efficiency Collaborate with interdisciplinary teams to support patient care and discharge planning Ensure compliance with hospital policies and clinical guidelines Apply now to join a team dedicated to delivering exceptional behavioral health care. Compensation: $72.00 per hour Great jobs. Great company. Great community of caregivers. At Aura Staffing Partners, we know that partnering with you to find the right opportunity in healthcare is just the beginning. We don't leave you high and dry, instead we help you grow even brighter with quarterly reviews, continued training and plenty of communication.

Pay Range: $73,500.00 - $110,300.00 Please email HR_Talent_************************** if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: Conduct pre and post payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care. Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality-of-care issues, and discharge planning. Document rationale for medical decisions made. Identify at-risk members who would benefit from health management programs through comprehensive health assessments. Monitor and evaluate patient's plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions. Promote member and provider satisfaction. Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan. Represent corporation in a responsible and professional manner. Participate in department initiatives and projects. Perform other duties as assigned. What you'll need to succeed: Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC) Three to five years acute medical or clinical experience or experience in utilization reviewed. Valid Driver's License (On-site only) Understanding of utilization review techniques including all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning Understanding of health care delivery system access points and services Correct application of health care management guidelines Ability to navigate the healthcare delivery system Advanced analytical skills, with the ability to interpret and synthesize complex data sets Good business acumen and political savvy Knowledge of business process improvement techniques and strategies Excellent verbal and written communications skills Negotiation skills Presentation skills Decision-making skills Good problem-solving skills Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects The extras: Bachelor's Degree in Nursing Certified Case Management certification, Certified Professional Utilization Review certification Experience working in a managed care/health maintenance organization Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit ************************************************************** to view the "Know Your Rights" poster.

· Participates in the development and ongoing implementation of QM Work Plan activities. · Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives Responsibilities: · Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. · Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. · Data gathering requires navigation through multiple system applications. · Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information. · Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. · Responsible for the review and evaluation of clinical information and documentation. · Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. · Works Potential Quality of Care cases across all lines of business (Commercial and Medicare). · Independently coordinates the clinical resolution with internal/external clinician support as required. · Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data · Prepares and completes QM documents based on interpretation and application of business requirements · Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements · Assists in the development and implementation of QM projects and activities · Accountable for completing and implementation of QM Work Plan Activities Experience: · 3+ years of experience as an RN · 1+ years of inpatient hospital experience · Registered Nurse in state of residence · Must have prior authorization utilization experience · Able to work in multiple IT platforms/systems Skills: · MUST HAVE MEDCOMPASS or ASSURECARE exp. · MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. · MUST HAVE UM experience, inpatient utilization management review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. · MUST HAVE 6 months of Prior Authorization. Education: · Active and unrestricted RN licensure in state of residence **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (*********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Discharge planning. Educate providers on utilization and medical management. Provide clinical knowledge. Perform onsite review of emergent/urgent and continued stay requests Qualifications 2+ years of clinical nursing experience in an acute care. Current state's RN license. Additional Information All your information will be kept confidential according to EEO guidelines.

Summary: SMOC Behavioral Healthcare is a division of SMOC that provides substance abuse and mental health outpatient services to individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must possess at least 2-3 years' experience billing 3 rd party insurance, work with Department of Public Health contracts. Why Work for SMOC? Paid Time Off: All full-time employees can accrue up to 3 weeks of vacation, and 2 weeks of sick time and are eligible for 12 paid holidays during their first year of employment. Employer-paid Life Insurance & AD&D and Long-Term Disability for full-time employees. Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing program, Dental Plans with Orthodontic Coverage, and EyeMed Vision Insurance available to full-time employees. 403(B) Retirement Plan with a company match starting on day one for all full-time and part-time employees. Additional voluntary benefits including; Term and Whole Life Insurance, Accident Insurance, Critical Illness, Hospital indemnity, and Short-Term Disability. Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more. Primary Responsibilities: Interface with the billing subcontractor. Work hand in hand with representatives from the billing contractor and the clinic front office to make adjustments in the health record to ensure all activities are billable to all payors. Ensure all client payor information and authorizations are entered into the electronic health record. Reconcile and resolve issues related to claims submissions, research and resolve eligibility issues, including contact with clients to inform of eligibility loss. Ensure all new and ongoing prior authorizations are entered for the Outpatient Clinic programs, Residential Recovery Programs. Ensure all billing to Department of Public Health is entered accurately and in a timely fashion, for the RRS and outpatient clinic programs. Review denials and partially paid claims and resolve discrepancies. Assist in resolving overdue claim problems. Run reports and gather data as needed for financial and operating reports. Recommend write-off and process in billing system as directed. Ensure compliance with program/department, agency and/or funder requirements, as well as, SMOC policies & procedures. Other duties as assigned. Knowledge and Skill Requirements: Associates Degree preferred or relevant experience Medical and/or Mental Health third party billing experience Experience with third party billing denial and resolution process Must have ability to handle multiple and changing priorities and meet deadlines Organizational Relationship: Directly reports to Operations Director. Indirectly reports to Director of Residential Recovery Programs. Direct reports of this position are none. Physical Requirement: Ability to ascend and descend stairs Ability to see and read Ability to lift up to 10lbs Dress is business casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with clients served by SMOC in various programs funded or administered through the Executive Office of Health and Human Services. Remote Work Option: Remote work is permissible in some positions at SMOC depending on the key functions and responsibilities. The Compliance Officer position is eligible to work from home 0-60% of the week in scheduling coordination with the department manager. Monday through Friday: 9:00AM - 5:00PM. Includes a 1-hour unpaid lunch break. 35 Hours per week.

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The Medicare UM Case Manager, RN performs utilization management activities primarily for Medicare Advantage, including review of authorizations for home care, high tech radiology, outpatient, inpatient, and post-acute services. The Medicare UMCM reviews the medical necessity of authorization requests using NCD, LCD, Medicare Benefit Policy Manual, medical policies, and InterQual criteria. Qualifications Education * Associate's Degree Nursing required; Bachelor's Degree Nursing preferred Licenses and Credentials * Massachusetts Registered Nurse license required * Basic Life Support [BLS Certification] Certification preferred Experience * At least 2-3 years of utilization management strongly preferred * Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Medicare Benefit Policy Manual preferred * InterQual experience preferred Knowledge, Skills, and Abilities * Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. * Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. * Ability to establish strong rapport and relationships with patients and staff. * Proficient in Microsoft Office and industry-related software programs. * Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. * Ability to maintain client and staff confidentiality. * Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. * Knowledge of Healthcare and Managed Care preferred. Additional Job Details (if applicable) Working Conditions * This is a remote role that can be done from most US states Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus