- Guthrie (Troy, PA)
- …$15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other ... aggregation associated with UM processes and operations. Experience Minimum of five years clinical experience in an acute health care setting. Must possess… more
- CenterWell (Harrisburg, PA)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- UPMC (Pittsburgh, PA)
- …optimal member care . Conducts comprehensive face-to-face assessments that include a clinical assessment and treatment, a review of the medical, functional, ... , and case management interventions. Updates the plan of care following review and communicates recommendations to...insurance experience preferred. + 1 year of experience in clinical , utilization management, home care ,… more
- UPMC (Pittsburgh, PA)
- …healthcare resource utilization , case management interventions. Update the plan of care following review and communicate recommendations to the member and ... other health plan and system departments as appropriate. + Review member's current medication profile; identify issues related to...insurance experience required. + 1 year of experience in clinical , utilization management, home care ,… more
- Penn Medicine (Philadelphia, PA)
- …to share this rewarding and **REMOTE RN** role! This role will focus primarily on utilization review which is why we are seeking individuals who have between 3 ... Bachelor of Arts or Science (Required) + Education Specialization:NursingEquivalent Experience:*2+ years Clinical Experience We believe that the best care for… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote...administration and clinical teams. + Experience in utilization management and care coordination. + In-depth… more
- Genesis Healthcare (Mechanicsburg, PA)
- …rehabilitation department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient ... Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical ...utilization with input from treating therapists, consideration of clinical requirements, and recommendations from the Clinical … more
- Centene Corporation (Harrisburg, PA)
- …in the week. Eligible for 4-10HR shifts, or 5-8HR shifts. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- St. Luke's University Health Network (Sellersville, PA)
- … in the communities we serve, regardless of a patient's ability to pay for health care . The Utilization Review (UR) Assistant manages and obtains all funding ... Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care /Outcomes, Customer/Service Improvement, Operational System/Process, and… more
- UPMC (Pittsburgh, PA)
- …Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including ... reviews, member grievances, provider appeals, and potential quality of care concerns. + Provide expedited review and...license. The ideal candidate will have 5-10 years of clinical experience, as well as managed care … more