- AmeriHealth Caritas (Philadelphia, PA)
- …the performance standards embodied in the HEDIS program. + Assuring a high-performing Medical Management system that adheres to the terms of contracts and ... information in order to develop interventions to improve clinical effectiveness of medical management strategies. + Works closely with a multidisciplinary team… more
- WellSpan Health (York, PA)
- WellSpan Medical Weight Management is seeking a dynamic Internal Medicine or Family Medicine physician who is board certified in Obesity Medicine. A good ... new patient & 20-minute follow-up. + May eventually develop a Pediatric Weight Management Program. **WellSpan Medical Group Offers:** + Secure employment with a… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective… more
- Penn State Health (Reading, PA)
- …veteran status, and family medical or genetic information._ **Position** Medical Office Associate - Pain Management **Location** US:PA:Reading | Clerical ... **Penn State Health** - **Community Medical Group** **Location:** US:PA:Reading **Work Type:** Full Time **FTE:** 1.00 **Shift:** Day **Hours:** Varied **Recruiter… 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)
- The Regional Medical Director, CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... utilization, and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of...hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management (UM) across… more
- Humana (Harrisburg, PA)
- …industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage… 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
- CVS Health (Harrisburg, PA)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... care management solutions that promote high-quality healthcare for members. We...Use established guidelines to authorize services or escalate to Medical Directors as needed. + Navigate multiple computer systems… more