- USG Insurance Services, Inc. (Pittsburgh, PA)
- …earned recognition for our excellence, being ranked as a 5-star MGA by Insurance Business of America for four consecutive years. Moreover, we take pride in ... our continuous acknowledgment as a Top Insurance Workplace over the past five years, as voted...be assisting with various tasks related to sales, client management , and administrative functions. Responsibilities include: + Requesting and… more
- Travelers Insurance Company (Blue Bell, PA)
- …cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management , negotiation and resolution) including maintaining full compliance ... (CFA) for adherence to quality standards. + Utilizes diary management system to ensure that all claims are handled...+ Communication - Advanced + Negotiation - Advanced + Insurance Contract + Knowledge - Advanced + Principles of… more
- Highmark Health (Pittsburgh, PA)
- …Description :** **JOB SUMMARY** The Director, Enterprise Expense Reporting & Data Management is a strategic leader responsible for the design, implementation, and ... of process innovation, and a vital liaison between cross-functional teams including management , data owners, and IT partners. Reports directly to the VP, Enterprise… more
- CVS Health (Pittsburgh, PA)
- …**Key Responsibilities:** **Regulatory Compliance & Mental Health Parity, Department of Insurance Audits and Market Checks** + Ensure template formularies design and ... application of utilization management (UM) criteria align with MHPAEA and other federal/state...to produce and validate data for exam requests. **Formulary Management ** + Develop and maintain CVS Caremark's template formularies… more
- Guthrie (Sayre, PA)
- …has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The Acute Case ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal and… more
- CVS Health (Harrisburg, PA)
- …APAC and Africa in support of an international network, medical cost management and overall claim/customer service strategies. This role will provide concierge level ... members via timely provision of required network access and proactive management of network relationships to ensure seamless direct settlement access. *Preference… more
- Select Medical (Hummelstown, PA)
- …Hospital** **Partnership with Select Medical** **Position:** Director of Case Management **Schedule:** Full-time Our Inpatient Rehabilitation Hospital is committed ... frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate discharge… more
- Merck (North Wales, PA)
- **Job Description** Global Project and Alliance Management (GPAM) sits in the Research & Development Division at our Company. The Project Managers in GPAM are core ... that improve human health and business. Under GPAM, the CMC Integrated Project Management (CIPM) organization was formed to enhance our Project & Portfolio … more
- SitusAMC (Harrisburg, PA)
- …in a Senior Associate level role or external equivalent. + Project management qualification (PMP), Certified Associate in Project Management (CAPM) preferred ... effectively with senior executives and cross-functional leadership teams. + Project management experience preferred + Excellent communication skills + High degree of… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the operational areas of care management , utilization ... initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following responsibilities… more