- Evolent (Harrisburg, PA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical… more
- LifePoint Health (Johnstown, PA)
- …is seeking a full-time Practice Manager for the CPG East Hills Primary Care and Medwell. The primary responsibilities of the Practice Manager include maintenance of ... specialty clinics and patient focused programs. Conemaugh Health System employs over 5,000 clinical and non- clinical staff, and over 450 physicians committed to… more
- Guthrie (Sayre, PA)
- …who demonstrates leadership and autonomy in nursing practice. Preferred experience with care management/ utilization review , and payer knowledge. Fast paced ... Up To $25,000 Sign On Bonus For Qualified RNs! Summary: The Care Coordinator-Transitional Care provides telephonic outreach to all patients that have been… more
- Humana (Harrisburg, PA)
- …insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... participate in meetings involving care management, provider relations, quality of care , audit, grievance and appeal and policy review . The Behavioral Health… more
- Penn Medicine (Philadelphia, PA)
- …for underprivileged patients. + Provide guidance and assistance to optimize patient flow, utilization , and space design for clinical practices. + Working with ... is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field… more
- Highmark Health (Monroeville, PA)
- …party payers. + Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract ... etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to… more
- Healthfirst (PA)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge ... Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize… more
- Evolent (Harrisburg, PA)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… more
- WellSpan Health (York, PA)
- …meetings on a regularly scheduled basis with individual staff to ensure safe quality care , progress towards goals, and proper utilization of services. * Provides ... of any clinical patient/staff related issues in the event patient care is/could be impacted.* Demonstrates leadership by example while promoting "Just Culture"… more
- Humana (Harrisburg, PA)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... MD or DO degree + 5+ years of direct clinical patient care experience post residency or...region or line of business. The Medical Director conducts Utilization Management of the care received by… more