- Highmark Health (Harrisburg, PA)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Harrisburg, PA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more
- UPMC (Pittsburgh, PA)
- …UMPC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, Utilization ... role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and… more
- Select Medical (Hummelstown, PA)
- …significant PI findings pertaining to adverse drug reactions, drug usage evaluation, medical management of acute transfers and other CQI indicators. ... with Select Medical & Penn State Health** **Director of Quality Management ** **(DQM)** + Bonus incentives + Extensive onboarding and training program +… more
- Guthrie (Sayre, PA)
- …Manager has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The ... Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b)… more
- Evolent (Harrisburg, PA)
- …for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- UPMC (Pittsburgh, PA)
- …proactive clinical interventions and serving in the design and implementation of medical management initiatives to improve quality and cost effectiveness of ... medical cost trend in partnership with network services and medical management teams including development of trend-specific initiatives and identification… more
- Humana (Harrisburg, PA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more
- CenterWell (Harrisburg, PA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health ... group practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more
- Humana (Harrisburg, PA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more