- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Bonus For Qualified RNs! Position Summary: The Acute Case Manager utilizes industry accepted processes for achieving optimal patient,...experience in an acute care setting with strong care management , utilization review , and payer… more
- Burns & McDonnell (Conshohocken, PA)
- …, Program Manager as well as internal and external executive management as required. + Collaborate with the engineering team to establish the development ... **Description** The Construction Project Manager supports the Engineer Procure Construct Project Manager or Program Manager to oversee day-to-day operations… more
- Highmark Health (Monroeville, PA)
- …to ensure inventory and supply spend accountability is established and monitored. Review inventory utilization data; audit inventory system information systems ... for the strategic implementation of supply chain initiatives and operational management throughout AHN hospitals and surgery centers. The Materials Manager… more
- UPMC (Murrysville, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- WellSpan Health (Lewisburg, PA)
- …safety and efficient care. Assists the Director of Clinical Operations in management of staff to deliver high quality, patient-centered care. Assists with directing ... practice and across transitions of care. + Responsible for hiring, performance review of Clinical Supervisors. + Collaborates with Practice Managers to provide… more
- UPMC (Pittsburgh, PA)
- …for the direct oversight of the day-to-day operations of the authorization, denial management , and/or utilization review functions of UPMC Revenue Cycle, ... Purpose: UPMC Corporate Revenue Cycle is hiring a Clinical Manager to join our Care Management Team!...+ Function as a resource person for authorization, denial management and/or utilization review processes.… more
- Highmark Health (Pittsburgh, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization...**Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association -… more
- Highmark Health (Monroeville, PA)
- …advisor and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization ... as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer...**Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association -… more