- Humana (Harrisburg, PA)
- …management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... cases. you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Harrisburg, PA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in… more
- Evolent (Harrisburg, PA)
- …initiatives. **What You Will Be Doing:** + Responsible for oversight of utilization management (UM)/care management (CM) correspondence development, internal ... to adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures… more
- UPMC (Pittsburgh, PA)
- …established policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including ... standards and professional developments in the areas of quality improvement and utilization management . + Communicate and educate network providers regarding… more
- Humana (Harrisburg, PA)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... community and help us put health first** The Medical Director relies on broad clinical expertise to review...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Rehab you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Radiology you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more