- Evolent (Harrisburg, PA)
- …critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process… more
- BriteLife Recovery (Hanover, PA)
- …of Nursing, Medical Director , and BHT Supervisor to deliver excellent client care . + Works with Utilization Review Department to address billing needs. ... CLINICAL DIRECTOR Do you work for a company that...ensuring compliance with state regulatory requirements, program development, financial management , accreditation standards, program marketing, staff recruitment and supervision,… more
- UPMC (Pittsburgh, PA)
- …parameters relative to patient volume and acuity. + Maintain high quality of patient care through utilization of quality assurance monitors, state of the art ... and maintain effective communication and cooperation with the Medical Director and Medical Staff as well as Nursing and...relevant field of study 5 years of clinical respiratory care experience including experience in a management /leadership… more
- UPMC (Pittsburgh, PA)
- **The Department of Surgical Oncology is seeking a strategic and results-driven Director of Operations to lead and support the operational, financial, and ... be responsible for driving operational excellence, ensuring high-quality patient care delivery, and aligning departmental goals with broader institutional… more
- CVS Health (Pittsburgh, PA)
- …background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs ... to address member needs across the continuum of care . Supports the Medical Management staff ensuring...responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides… more
- Humana (Harrisburg, PA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance ... our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals.… more
- Stantec (Philadelphia, PA)
- When you care deeply about the work you do, it's rewarding to see it through from concept to completion. We partner with clients to provide both program ... management and construction management to strategize, plan,...**Your Opportunity** Stantec is seeking an Owner's Representative, Project Director for the Commonwealth of PA, Redevelopment Assistance Grant… more
- Merck (North Wales, PA)
- …observational studies to characterize disease burden and epidemiology, treatment patterns, health- care resource utilization and costs, physician and patient ... **Job Description** **Role Summary:** + The Executive Director , Value & Implementation (V&I) Outcomes Research position resides in the V&I organization, which… more
- Prime Therapeutics (Harrisburg, PA)
- …implementation of innovative drug solutions, including optimizing optimize drug utilization , patient outcomes, and cost-effectiveness through value-based care ... drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE...years of work experience within medical and pharmacy drug management within a PBM or managed care … more
- LifePoint Health (Johnstown, PA)
- …the case management program.Ensure staff competencies in all areas of care management to include utilization review, transition/discharge planning, ... Department in an acute care hospital. . Working knowledge of Care Management department functions including Joint Commission and Conditions of Participation… more