- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. ... hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management ...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- Wellpath (Lemoyne, PA)
- …**How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , quality ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… 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 ... Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes,… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management , ... policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs. ;The… 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)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Devereux Advanced Behavioral Health (West Chester, PA)
- …setting. Two (2) years of previous supervisory experience. Previous experience in utilization review and/or admissions. Proficient computer skills, mastery of ... joining our Devereux Advanced Behavioral Health team as a ** Director of Quality Improvement** ! The ** Director ...a ** Director of Quality Improvement** ! The ** Director of Q** **uality Improvement** works closely with all… more
- UPMC (Media, PA)
- …care delivered to Community Care members. This includes significant responsibility for quality management and utilization management and for assuring the ... MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information...backup for other business units + Advises the Regional Director on the development and review of… more
- Evolent (Harrisburg, PA)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Harrisburg, PA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of...size of region or line of business. The Medical Director conducts Utilization Management of… more