- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Harrisburg, PA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Humana (Harrisburg, PA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Harrisburg, PA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Harrisburg, PA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Harrisburg, PA)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- UPMC (Pittsburgh, PA)
- …The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... appropriate setting and cost - effective manner. **Responsibilities:** + Review and document clinical information from health care providers...of 2 years of experience in a clinical and/or case management nursing required. + Work experience… 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 ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more
- Datavant (Harrisburg, PA)
- …###@datavant.com . We will review your request for reasonable accommodation on a case -by- case basis. For more information about how we collect and use your ... benchmarking, goal setting, timely execution, and superior leadership. + Strong utilization of SalesForce to include monitoring and documenting member information. +… more
- Highmark Health (Harrisburg, PA)
- …insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) ... Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies,… more