- WellSpan Health (York, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... between visits. + Assists in the management of patient utilization of health care system and provides...services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned… more
- WellSpan Health (Chambersburg, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... between visits. + Assists in the management of patient utilization of health care system and provides...services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **JOB SUMMARY** This position is eligible for a $5,000 sign on bonus for a 1-year commitment This role ... overseeing referral screening/management. **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management: Reviews pharmacy utilization management (UM)… more
- Highmark Health (Harrisburg, PA)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Veterans Affairs, Veterans Health Administration (Erie, PA)
- …of the Recreation Therapy Services for the facility's 8 bed domiciliary with the Behavioral Service at Erie VA Medical Center. This position is of an integrated ... that contributes to the therapeutic goals for Veterans diagnosed primarily with mental health and/or substance use disorders, as well as a variety of complex medical… more
- Highmark Health (Harrisburg, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Responsible for all aspects of clinical appeal activities to include but not ... + Bachelor's Degree in Nursing + 1 year in Utilization Management or Utilization Review + 1...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job is responsible for recommending and implementing strategic and ... plans impact a portfolio >3 million SF.10% + Space Utilization /Key Metrics - supports the space standards and metrics...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Optimizes patient care by promoting rational, safe, and cost effective drug ... evaluation of medical literature, rounding with medical services, drug utilization reviews/monitors and patient counseling. (20%) + Plans, implements, performs… more
- Highmark Health (Harrisburg, PA)
- …itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education ... successful and measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes qualitative and… more
- Highmark Health (Harrisburg, PA)
- …and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, information, ... AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness and… more