- UPMC (Hanover, PA)
- …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM… more
- AmeriHealth Caritas (Newtown Square, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- WellSpan Health (Lebanon, PA)
- …Duties and Responsibilities + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and...Life Support Upon Hire Required + Certified in Case Management Preferred Knowledge , Skills, and Abilities: +… more
- St. Luke's University Health Network (Allentown, PA)
- …patient's ability to pay for health care. The IT Vendor and Contracts Manager leads IT's Vendor/Contact Management Office (VCMO). Responsibilities include but ... and attainment, reporting and governance. At an operational level, the Manager directs contract consultations and negotiations, including contract reviews, analysis,… more
- UPMC (Washington, PA)
- **Purpose:** The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable ... care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and… more
- Magellan Health Services (Bethlehem, PA)
- …Provides support to Care Managers and other clinical team members through content knowledge , technical and utilization management expertise. Researches open ... License (BSL) in the state of Pennsylvania is required.* Knowledge of DSM V or most current diagnostic edition.*...unresolved issues for Care Managers who are providing direct utilization management services. Mentors new Care Managers… more
- Highmark Health (Wexford, PA)
- …effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family ... or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case … more
- Boehringer Ingelheim (Pittsburgh, PA)
- …an overview of our benefits please click here. **Description** The Strategic Account Manager will uncover opportunities for utilization of approved BI oncology ... in appropriate patient types. This individual will serve as strategic account management lead to engage Marketing, Specialty Market Access/HEOR, Health Systems, and… more
- UPMC (Latrobe, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... to enhance their knowledge and skills related to health or lifestyle management . + Contact members with gaps in preventive health care services and assist them… more
- UPMC (Greensburg, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... to enhance their knowledge and skills related to health or lifestyle management . + Contact members with gaps in preventive health care services and assist them… more