- Wellpath (Collegeville, PA)
- …healthcare staff and ensure adherence to clinical protocols + Oversee chronic care clinics, utilization review , and quality improvement initiatives + ... a very large percent of those individuals receive direct clinical care , which includes lives saved by... review . **Key Responsibilities** + Provide direct medical care and document all clinical encounters in… more
- Genesis Healthcare (York, PA)
- …years of clinical nursing experience is required. Prior experience in utilization review , case management or discharge planning is required. Prior experience ... network of owned and managed centers is effectively managing resource utilization , improving clinical outcomes, maximizing reimbursement, complying with… more
- Guthrie (Sayre, PA)
- …aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social ... data for decision making, PI planning, and strategic planning + Responsible for the clinical Utilization Management component of the Revenue Cycle + Assures UM… more
- Highmark Health (Harrisburg, PA)
- …to a team of clinical pharmacists as members of a multi-stakeholder care team responsible for ensuring appropriate drug utilization across the pharmacy and ... of the pharmacists who will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across both the… more
- CVS Health (Harrisburg, PA)
- …Counselor) **Preferred Qualifications** + Crisis intervention skills preferred + Managed care / utilization review experience preferred + Case management ... and optimal, cost-effective outcomes. Assessment of Members: Through the use of clinical tools and information/data review , conducts comprehensive assessments of… more
- UPMC (Pittsburgh, PA)
- …with doctors, nurses, and other professionals to deliver personalized, patient-centered care . You'll also contribute to clinical research, mentor pharmacy ... service lines, clinical areas, and therapeutic programs. + Facilitates pharmaceutical care services, direct patient care programs, medication utilization … more
- UPMC (Pittsburgh, PA)
- …service lines, clinical areas, and therapeutic programs. + Facilitates pharmaceutical care services, direct patient care programs, medication utilization ... **UPMC Children's is hiring a Full Time Clinical Pharmacist!** **This Clinical Pharmacist position...services and care areas to assure drug utilization activities are aligned with patient care … more
- Fresenius Medical Center (Baden, PA)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... all regulatory and FMS policy requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all… more
- Humana (Harrisburg, PA)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... societies + Please note this role will consist of working mostly independently to review at times large amount of clinical information to update clinical… more
- Highmark Health (Harrisburg, PA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more