• Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners… more
    Wellpath (08/08/25)
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  • LPN Utilization Mgmt Reviewer - Medical…

    Guthrie (Troy, PA)
    Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of...with members of the healthcare team. + Proactively researches case findings related to payer audits of UM decisions… more
    Guthrie (07/15/25)
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  • Clinical Reimbursement Case…

    Genesis Healthcare (York, PA)
    …care management goals. 9. Works collaboratively with the Director or Sr. Director of Case Management to update strategic business plan and ensure ... In conjunction with the Director or Sr. Director , acts as case management ...of clinical nursing experience is required. Prior experience in utilization review, case management or… more
    Genesis Healthcare (07/01/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Sayre, PA)
    …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...and community providers. a) Works closely with the Medical Director and other members of the healthcare team to… more
    Guthrie (07/17/25)
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  • Case Management Manager - UPMC

    UPMC (Washington, PA)
    The Manager oversees the day-to-day operations of the Case management department under the direction of the Director . The Manager is accountable for the ... identified needs of Case Management staff + Assists with management of departmental budget. + Collaborates with Director , Medical Director /Physician… more
    UPMC (07/11/25)
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  • Medical Director - Florida

    Humana (Harrisburg, PA)
    …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
    Humana (07/29/25)
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  • Medical Director - South Central

    Humana (Harrisburg, PA)
    …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
    Humana (07/11/25)
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  • Medical Director - NorthEast Region

    Humana (Harrisburg, PA)
    …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
    Humana (07/25/25)
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  • Medical Director , MSK Surgery

    Evolent (Harrisburg, PA)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
    Evolent (05/20/25)
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  • Field Medical Director , Interventional…

    Evolent (Harrisburg, PA)
    …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
    Evolent (07/30/25)
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