- Evolent (Harrisburg, PA)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Guthrie (Sayre, PA)
- …the Core Values in all activities. Mentors under the Clinical Manager / Director and pursues management and leadership training within the Guthrie Robert ... related to interviews, new hires, transfers, promotions, evaluations, and performance management issues. In collaboration with manager / director recommends… 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. ... integrated health care, achieve clinically appropriate and financially sound resource utilization , support the insurance verification team, clinical staff and verify… more
- CenterWell (Lancaster, PA)
- …of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. + ... objectively, in consultation with the Human Resources Department and the Executive Director / Director of Operations. + Participates in the interviewing, hiring,… more
- Gentiva (Canonsburg, PA)
- …Illness Management (AIM) program** will report directly to the Director of AIM. Responsible for identifying and coordinating patient/family needs and for ... for the designated teams and functions as an interdisciplinary advanced illness management and support, along with telephonic, video, and in person interventions… more
- Highmark Health (Pittsburgh, PA)
- …Therapeutics Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior ... account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and disease management initiatives.… more
- Sanofi Group (Moosic, PA)
- …data into meaningful, action-oriented business insights towards optimizing resource utilization and revenue. The ideal candidate is passionate about leveraging ... complex problems. This position will report to the Sr. Director , Analytics - VaxServe. This role is based in...data into meaningful, action-oriented business insights that improve resource utilization and increase revenue. + Develop and adhere to… more
- St. Luke's University Health Network (Bethlehem, PA)
- …recommendations and actions. SUPERVISION (RECEIVED BY AND/OR GIVEN TO): Received: Pharmacy Management - Clinical coordinator, site director of pharmacy, network ... the hematology/oncology providers, and infusion centers to monitor chemotherapeutic utilization , supportive drug therapy utilization , adverse drug reactions,… more
- Select Medical (Mckeesport, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...medical record documentation. You will report directly to the Director of Case Management and provide social… more
- Select Medical (York, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...medical record documentation. You will report directly to the Director of Case Management and provide social… more