• Regional Medical Director, Care Management…

    UPMC (Pittsburgh, PA)
    The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
    UPMC (07/11/25)
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  • Utilization Review RN Case Manager…

    Penn Medicine (Philadelphia, PA)
    …or Equivalent Experience: + Bachelor of Arts or Science (Required) + Utilization Review experience (Required) + Bachelor's Degree in Nursing required.2+ ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
    Penn Medicine (08/19/25)
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  • Medical Director - Utilization…

    UPMC (Pittsburgh, PA)
    The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
    UPMC (06/12/25)
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  • Medical Director Utilization…

    AmeriHealth Caritas (Philadelphia, PA)
    …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
    AmeriHealth Caritas (08/12/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    … Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and practice ... staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management… more
    Wellpath (08/08/25)
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  • Staff Utilization Management Pharmacist

    Humana (Harrisburg, PA)
    …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review ​ **Additional Information:** **Interview Format**… more
    Humana (08/27/25)
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  • RN Registered Nurse Utilization Management…

    Penn State Health (Hershey, PA)
    …###@pennstatehealth.psu.edu (MAILTO://###@pennstatehealth.psu.edu) **SUMMARY OF POSITION:** Responsible for the review of clinical documentation in the Electronic ... **Penn State Health** - **Hershey Medical Center** **Location:** US:PA: Hershey **Work Type:** Full...an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with… more
    Penn State Health (08/20/25)
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  • Utilization Management Administration…

    Humana (Harrisburg, PA)
    …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
    Humana (08/23/25)
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  • Director Financial Investigations & Provider…

    Highmark Health (Pittsburgh, PA)
    …fraud, waste and abuse (FWA) programs and fraud awareness training, (d) participates on Medical Review Committee (MRC), including being a key liaison to external ... and civil law related to insurance fraud and advances in the post-payment utilization review process + Comprehensive knowledge of legal and investigative… more
    Highmark Health (08/08/25)
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  • Field Medical Director, Interventional…

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical ...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
    Evolent (07/30/25)
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