- Wellpath (Lemoyne, PA)
- …month over month and a very large percent of those individuals receive direct clinical care , which includes lives saved by Narcan. We offer ongoing training ... clinical resources for training, education, and point of care support. **How you make a difference** The Medical...Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Utilization Management provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement ... practice guidelines throughout the provider network. + Overseeing the quality of clinical care for network and non-network providers. + Engaging the… more
- Humana (Harrisburg, PA)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : ... part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical… more
- CenterWell (Harrisburg, PA)
- … clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + ... 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
- Evolent (Harrisburg, PA)
- …you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- UPMC (Mckeesport, PA)
- …+ Knowledge and Skills:Expertise in care management, discharge planning and utilization review processes. + Ability to build credible and effective ... UPMC McKeesport's Addiction Medicine Unit is searching for a Supervisor of Clinical Care and Discharge Planning! Join our dedicated team on UPMC McKeesport's… more
- CenterWell (Lancaster, PA)
- … of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... on-site at our Lancaster, PA branch location.** The **RN Clinical Manager** coordinates and oversees all direct care...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- UPMC (Mechanicsburg, PA)
- …required.KNOWLEDGE AND SKILLS:Expertise in care management, discharge planning and utilization review processes. Ability to build credible and effective ... The Manager oversees the day-to-day operations of the Clinical Care Coordination and Discharge Planning Department under the direction of the Director. The… more
- UPMC (York, PA)
- **Purpose of the Point of Care Coordinator:** Oversee the day-to-day operations of Point of Care (POC) testing activities outside of the hospital main ... and identify opportunities for process improvement in conjunction with patient care departments. Enforce and adhere to laboratory compliance policies + Evaluate… more
- Evolent (Harrisburg, PA)
- …Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more