- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Wellpath (Lemoyne, PA)
- …Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and practice ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key… more
- Highmark Health (Pittsburgh, PA)
- …and civil law related to insurance fraud and advances in the post-payment utilization review process + Comprehensive knowledge of legal and investigative ... execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and investigation… more
- Evolent (Harrisburg, PA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director … more
- Centene Corporation (Harrisburg, PA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- UPMC (Media, PA)
- …and serves as a backup for other business units + Advises the Regional Director on the development and review of programs, positions, and budgets having ... (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical Director is responsible… more
- Humana (Harrisburg, PA)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
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