- IQVIA (Wayne, PA)
- …trends in complex data sets. + Provide Business Consulting and Project Management : The candidate will apply consulting methodologies to deliver engagements, create ... clients, manage projects, cultivate professional relationships with client teams, and work with management to prioritize needs. As a member of the team, you will… more
- CVS Health (Harrisburg, PA)
- …and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination ... will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. In this role you will provide clinical expertise… more
- CVS Health (Harrisburg, PA)
- …Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a ... As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes...eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state… more
- Guardian Life (Bethlehem, PA)
- …individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to ... Knowledgeable in a variety of medical and behavioral health conditions + Vendor management : Works collaboratively with vendors to schedule and follow up for vendor… more
- Guardian Life (Bethlehem, PA)
- …You may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to facilitate ... + Able to demonstrate self-awareness and embrace feedback. **You will** + Review information in file, obtain medical information needed and/or acquire certification… more
- Lincoln Financial (Radnor, PA)
- …provide subject matter expertise regarding opportunities to optimize the adoption & utilization of implemented AI based solutions. **What you'll be doing** + Scope ... opportunities with the highest value potential and impact. + Documents the business case of the proposed AI based solutions, including the expected financial and… more
- Highmark Health (Wexford, PA)
- …with all regulatory agency requirements **ESSENTIAL RESPONSIBILITIES** + Reviews pharmacy utilization management (UM) coverage requests and prepares such cases ... for clinical review by a pharmacist and/or medical director when required....context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal… more
- Nestle (Lower Gwynedd, PA)
- …prevent recurrence are effectively implemented while also ensuring an effective injury case management process is fully implemented, well understood, and ... + Risk Assessment and Elimination - Leads the effective implementation and utilization of risk assessment and risk prediction processes across sites to ensure… more
- Penn Medicine (Philadelphia, PA)
- …including, but not limited to individual and group counseling as well as case management services to assigned patient caseload. The Addictions Counselor is ... monthly individual counseling services to patients.Conducts intakes, assessment and utilization review services.Ensures compliance with all documentation… more
- Penn Medicine (Sellersville, PA)
- …to patient arrival. * Assesses information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness. * ... departments included but not limited to admissions, business office, case managers and medical staff, nursing and designees. *...internet, and insurance portals. * Follows up with all review companies on all pending authorizations and referrals. *… more