- 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
- Genesis Healthcare (Norristown, PA)
- …of the rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification ... Area Director ). 11. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and… more
- 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
- Sedgwick (Harrisburg, PA)
- …**PRIMARY PURPOSE** :: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for ... offices and on site at client locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer… more
- Penn Medicine (Philadelphia, PA)
- …to payer to obtain pre-certification and assure reimbursement.Identify potential quality and utilization concerns and refer to the Director when appropriate. ... + Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required)… more
- Select Medical (Mckeesport, PA)
- …, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as ... right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Select Medical (York, PA)
- …, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as ... right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Devereux Advanced Behavioral Health (Malvern, PA)
- …their families. Management of the fiscal budget to include bed utilization , FTE planning/ utilization and monitors other operational expenses and sources of ... Are you skilled in managing behavioral health funding, reimbursements and bed utilization ? Do you excel at fostering a work environment that promotes accountability,… more
- Highmark Health (Pittsburgh, PA)
- …budgetary responsibility and authority. + Provides daily direction and oversight to management and team leads regarding case investigation activities including ... the development of detailed strategies for each case . Ensures management and staff are aware of all regulatory and customer requirements regarding the… more
- CVS Health (Harrisburg, PA)
- … will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. In this role you will provide clinical ... of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum...consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization… more