Jobs in the United States

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Oliver Wyman Partner & Supervisory Principal
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Sales Advisor, RTW - Fendi DSA, Bergdorf Goodman
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Added 3 mins ago
Facilities Manager
Wright Service Corp.
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Job Summary: The Facilities Manager is responsible for overseeing the maintenance, safety, security, and operational effectiveness of multiple company facilities. This role manages facility…
Added 3 mins ago
Contract Specialist II - Supply Chain/Distribution
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Contract Specialist II - Sourcing/Procurement
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Assists Senior Manager, Contract Management with complex contracting issues.
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Consortium Operations Manager
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The Consortium Operations Manager leads the day-to-day operational execution of the Genesis Mission Consortium, translating strategic priorities and contractual commitments into coordinated…
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Hybrid: This hybrid role is based in Tampa FL and requires collaboration in the office three (3) days per week · Must be available to collaborate onsite at MHK’s Tampa office at least three days per week
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CHIEF IT MANAGER
State of Nevada (NV)
Carson City, NV · Las Vegas, NV · North Las Vegas, NV
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Added 7 mins ago
Community Manager - Sugar Land area
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Added 7 mins ago
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Maintenance Supervisor - Museum Terrace
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Service Supervisor- Westlink at Oak Station-
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Incumbents must have all licenses and/or certifications as required by State and Local jurisdictions
Added 8 mins ago
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- $140,000 to $165,000 USD / year
Accelerate: move deals Sales already sees by getting more of the buying committee into our rooms and our programs.
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Assistant Store Manager
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Assistant Store Manager
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Assistant Store Manager
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Conference Associate
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Added 15 mins ago
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Social Media Manager Intern - Summer 2027
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- $35 USD / hour
…of our players and community through games. The University Programs team also invites you to intern focused events so you can connect with your fellow interns and Rioters to make the most…
Added 15 mins ago
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Community Manager Intern - Summer 2027
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Los Angeles, CA
- $33.94 USD / hour
As a Community Management Intern, you’ll work with Riot Games’ community teams to help execute programs and initiatives that deepen community engagement, build strong influencer…

Closed listing

Elevance Health

Utilization Management II

Mason, OH, United States
Tampa, FL, United States
Durham, NC, United States

This opening has closed.

The original listing is kept below for reference.

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Posting language: English
Posted: Nov 9, 2026

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Original job description

Archived listing. The details below describe a past opening.

Utilization Management Representative II

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. The position will be based on Mason - OH, Durham- NC and Tampa -FL.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour from shift 8:00 am - 5:00 pm (EST) Monday to Friday. Additional hours may be necessary based on company needs.

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

The Utilization Management Representative II responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.

How you will make an impact:

Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Obtains intake (demographic) information from caller.
Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
Verifies benefits and/or eligibility information.
May act as liaison between Medical Management and internal departments.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.

Minimum Qualifications:

Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

Intermediate experience with excel is strongly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Certain contracts require a Master's degree.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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Jobs in the United States