Pharmacy Benefit Coordinator
$67K - $72K/yr
Experience supporting utilization management/prior authorization processes. EEOC Statement: Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on ...
New
$67K - $72K/yr
Experience supporting utilization management/prior authorization processes. EEOC Statement: Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on ...
New
$67K - $72K/yr
Experience supporting utilization management/prior authorization processes. EEOC Statement: Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on ...
New
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
New
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
New
$66K - $125K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $125K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $119K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $119K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $125K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $125K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $119K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
$66K - $119K/yr
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. * For URAC accredited areas, the following ...
Washington, DC · On-site
$80K - $115K/yr
This role will oversee daily operations within a highly collaborative, multidisciplinary clinical resource management team focused on patient throughput, utilization management, intake coordination ...
Washington, DC · On-site
$80K - $115K/yr
This role will oversee daily operations within a highly collaborative, multidisciplinary clinical resource management team focused on patient throughput, utilization management, intake coordination ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Hanover, MD · On-site
$115K - $172K/yr
Implements and manages health care management, utilization, cost, and quality objectives. * Ensures program compliance and identifies opportunities to improve the customer service and quality ...
Lead strategic practice initiatives with guidance from HAP leadership, including staffing and utilization management, headcount forecasting, staff performance management, staff learning and ...
New
Lead strategic practice initiatives with guidance from HAP leadership, including staffing and utilization management, headcount forecasting, staff performance management, staff learning and ...
New
Field Medical Director, Radiation OncologyAs a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non ...
Field Medical Director, Radiation OncologyAs a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non ...
Arlington, VA · On-site
Field Medical Director, Radiation Oncology As a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non ...
Arlington, VA · On-site
Field Medical Director, Radiation Oncology As a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non ...
Washington, DC · On-site
$33.60 - $50.40/hr
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Washington, DC · On-site
$33.60 - $50.40/hr
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Washington, DC · On-site
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Washington, DC · On-site
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Field Medical Director, Radiation Oncology As a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non ...
Field Medical Director, Radiation Oncology As a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non ...
Leesburg, VA · On-site
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
Leesburg, VA · On-site
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
Leesburg, VA · On-site
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
Leesburg, VA · On-site
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
Washington, DC · On-site
$74K - $134K/yr
Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field ...
Washington, DC · On-site
$74K - $134K/yr
Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field ...
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
$15.25 - $19.25/hr
Responsible for ensuring all clinical staff are following Utilization Management and Revenue Cycle Management guidelines to ensure correct coding and billing of services. * Manages escalated concerns ...
$44.2K - $57.4K
9% of jobs
$67.2K is the 25th percentile. Wages below this are outliers.
$57.4K - $70.6K
22% of jobs
$70.6K - $83.9K
11% of jobs
The median wage is $92K / yr.
$83.9K - $97.1K
14% of jobs
$97.1K - $110.3K
12% of jobs
$118.6K is the 75th percentile. Wages above this are outliers.
$110.3K - $123.6K
13% of jobs
$123.6K - $136.8K
13% of jobs
$136.8K - $150K
5% of jobs
$150K - $163.2K
2% of jobs
$163.2K - $176.5K
0% of jobs
$176.5K - $189.7K
0% of jobs
$44.2K
$103.1K
$189.7K
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
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.

$67K - $72K/yr
Other
Medical, Dental, Vision, Life, Retirement, PTO
Posted 3 days ago
New
Description
Summary:
The Pharmacy Benefit Coordinator is responsible for supporting clinical outreach services to our members, their pharmacies, and their healthcare providers to ensure member safety, minimize gaps in care, identify cost-effective medication strategies, and coordinate care to improve healthcare outcomes for our members. The position will support HEDIS adherence initiatives and work to support longitudinal improvement goals.
In addition, the Pharmacy Benefit Coordinator performs a variety of routine to moderately complex administrative and pharmacy-related tasks that support the Pharmacy Management team within the department. The Pharmacy Management team is responsible for managing the pharmacy benefits for Maryland Physicians Care in collaboration with the pharmacy benefit management (PBM) vendor and the organization's utilization review, quality improvement, provider relations, and population health initiatives.
About Maryland Care Management, Inc. (MCMI)
Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.
Why join us?
MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.
Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to impact our members' lives positively.
What You'll Do:
Requirements
Knowledge and Skills:
EEOC Statement: Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment. As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive. We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.