- UPMC (Pittsburgh, PA)
- …collaborate effectively with hospital administration and clinical teams. + Experience in utilization management and care coordination. + In-depth ... The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management ...documentation of all physician advisory activities in the UPMC Care Management information system. + Conduct or… more
- Humana (Harrisburg, PA)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Harrisburg, PA)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management , ... and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the...those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Wellpath (Lemoyne, PA)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a… more
- Evolent (Harrisburg, PA)
- …**Collaboration Opportunities:** + The Manager, Client Services oversees daily utilization management and directs the medical care of our members on behalf ... plans and serves in a supporting role to the Director , Intake and Utilization Management ...Utilization Management experience in a population management or managed care /insurance or hospital medical… more
- 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, ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- CenterWell (Harrisburg, PA)
- … Care 's) highest need and complexity patients with care and case management services. The Director is response for the strategic direction, execution and ... incumbent will play a pivotal role in reducing acute care utilization for top 5% of complex...Risk Patient Management (HRPM) program, Transitions of Care Management (TCM) program, and Episodic Consult… more
- UPMC (Pittsburgh, PA)
- …patient care through innovation? UPMC Nursing is seeking a dynamic Director , Virtual Care Center to launch enterprise-wide virtual nursing initiatives. In ... centralized cardiac monitoring unit and other aspects of virtual care programs. The Director is responsible for.... + Develops and implements new areas of clinical utilization for all Virtual Care programs. +… more