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Manager Utilization Management Jobs in Missouri (NOW HIRING)

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Manager Utilization Management information

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are popular job titles related to Manager Utilization Management jobs in Missouri? For Manager Utilization Management jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Missouri look for? The top searched job categories for Manager Utilization Management jobs in Missouri are:
What cities in Missouri are hiring for Manager Utilization Management jobs? Cities in Missouri with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Missouri as of August 2026, with employment types broken down into 81% Full Time, 13% Part Time, 1% Temporary, and 5% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Clinical Pharmacist - Utilization Management Archimedes

Navitus Health Solutions, LLC

Earth City, MO • On-site, Remote

$112K - $134K/yr

Full-time

Posted 8 days ago

Navitus Health Solutions rating

7.0

Company rating: 7.0 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

260th of 483 rated business services

Job description

Archimedes
Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit alignment, value and transparency Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
USD $0.00 - USD $0.00 /Yr.
0.00 - Ineligible
M-F 8am to 5pm Hybrid In Office- 3 Days

Archimedes is a specialty drug management company with industry-leading technology and services that health plans and employer groups can use to manage specialty drug spend. We are expanding our team and looking for a clinical professional who has specialty drug management experience and a passion for cost management. Given our continued growth trajectory, we are looking for a person who can grow with the company.

This role will be divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies.

The Clinical Pharmacist is responsible for being the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This individual will be able to successfully communicate with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions and cost management related to specialty drugs. Clinical subject matter expert is required to conduct peer to peer consultations with physicians.

Position can be located in either our Brentwood, TN or St Louis, MO offices.  Remote employment also considered.  


  • Develop and deliver clinical messages to physicians, members, clients, and consultants
  • Manage prior authorization, high-cost cases, claims editing and clinical policy development
  • Clinical program development including both medical and pharmacy benefit management
  • Define, document, and deliver results for plan sponsors.
  • Evaluate and summarize clinical literature as well as financial implications related to medication management options
  • Ability to present deep clinical and cost effectiveness information as a peer-to-peer consult.

  • Doctor of Pharmacy (PharmD)
  • Current pharmacist license (RPh) in good standing with a State Board of Pharmacy
  • Board of Pharmacy Certification, preferred for Pharmacotherapy, Ambulatory Care or Oncology Care
  • 3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred.
  • Pharmacy and Medical specialty benefit knowledge and experience
  • Independent, proactive, forward-thinking, creative problem solver, results-oriented
  • Ability to work well in team environment
  • Strong verbal/written communication skills
  • Strong physician-facing clinical communication skills
  • Microsoft Excel, Power Point and Word proficiency

502 Earth City Expy STE 300
Earth City
MO
63045

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