- Evolent (Harrisburg, PA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- Highmark Health (Pittsburgh, PA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, working with… more
- Penn Medicine (Lancaster, PA)
- …and development of effective plans of care to assure appropriate utilization and promote appropriate qualitypatient care and positive patient outcomes. ... to determine patient needs, reviewing the reliability of functionalscore as needed, and review primary diagnosis codes for alignment with POC and reason from the… more
- Cherry Bekaert (Harrisburg, PA)
- …Resource Coordinator will effectively fill resource engagement requests overseeing the utilization of resources, ensuring alignment of resources with the strategic ... at least 100 people with minimal oversight from a manager . + Collaborate with engagement teams to understand their...trusted business advisor for service leads. + Generate scheduling, utilization and forecasting reports and provide analysis of the… more
- UPMC (Pittsburgh, PA)
- …based on education and nursing experience for Sr. Professional Care Manager within the Community and Ambulatory Services Division. **Responsibilities:** + Provides ... face-to-face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral, pharmaceutical, and social needs of… more
- Teva Pharmaceuticals (North Wales, PA)
- …Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into Medicaid systems ... ensure rebate eligibility and data consistency. + Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for… more
- Fujifilm (Harrisburg, PA)
- …request volume, and the like. This role works collaboratively with their manager , Subject Matter Experts (SMEs), Marketing & Communications team members, business ... identifying activities, sponsorships, and equipment needed to ensure success. + Review and consideration of event participation levels and requirements, involving… more
- Penn Medicine (Philadelphia, PA)
- …critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and ... shifts but are fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the perfect transition career for you, and will bring… more
- Penn Medicine (Philadelphia, PA)
- …program with requisite licensures and credentialing obtained. Works closely with the Manager of Faculty Affairs to align and maintain faculty academic plans. + ... report on budget variances, including operational drivers and external impacts. + Review , analyze, summarize, and interpret financial data. + Oversee preparation of… more
- Ryder System (Chambersburg, PA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **_This position ... operation. This position reports to the Lead Engineer, CI Manager or Sr. CI Manager and is...experience in core engineering and data analysis functions (slotting, utilization , labor planning, layouts, metrics, etc.) intermediate required +… more