- 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)
- …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- Penn Medicine (Lancaster, PA)
- …license and daily access to an insured vehicle. Preferred Qualifications + Knowledge of Utilization review or managed care + Experience with home visits + ... and coordinating care across various services, including hospital, specialty, and community health resources. The ideal candidate will be a Social Worker with strong… more
- University of Pennsylvania (Philadelphia, PA)
- …Life, and Flexible Spending Accounts : Penn offers comprehensive medical, prescription, behavioral health , dental, vision, and life insurance benefits to protect ... professional development opportunities, supportive work and family benefits, a wealth of health and wellness programs and resources, and much more. Posted Job Title… more
- Highmark Health (Harrisburg, PA)
- …effective application of appropriate design standards, methods, and tools. + Review application designs to ensure optimal technology selection, efficient resource ... utilization , and seamless system integration. + Ensure system architecture...automation scripts (Shell, Python) for streamlining tasks, ensuring peer review and version control. + Maintain comprehensive technical documentation,… more
- Highmark Health (Monroeville, PA)
- …to ensure inventory and supply spend accountability is established and monitored. Review inventory utilization data; audit inventory system information systems ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Commonwealth of Pennsylvania (PA)
- …with disruptive, emotionally improper, and suicidal youth. Through the utilization of appropriate physical restraint techniques, you will prevent escapes, ... individuals in an organized program, and a bachelor's degree in the behavioral sciences, special education, juvenile justice, or criminal justice; or + An… more
- CenterWell (Harrisburg, PA)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... review organization, such as Medicare Advantage,managedMedicaid, or Commercial health insurance. + Experience with national guidelines such as MCG(R) or… more
- University of Pennsylvania (Philadelphia, PA)
- …Life, and Flexible Spending Accounts : Penn offers comprehensive medical, prescription, behavioral health , dental, vision, and life insurance benefits to protect ... opportunities, supportive work and family benefits, a wealth of health and wellness programs and resources, and much more....written materials, documents are prepared in timely manner for review and distribution to meet all deadlines. Also ensures… more
- The Cigna Group (Philadelphia, PA)
- …several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life ... demographic data for assigned markets, ensuring accuracy and compliance. + Lead monthly review sessions with the contracting team to ensure the best line of sight… more