- 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
- UPMC (Pittsburgh, PA)
- …policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, ... Family Practice, Internal Medicine, or Emergency Medicine Physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Guthrie (Troy, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b)… more
- UPMC (Media, PA)
- …Director meetings and sits on appropriate committees of the PH MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical ... Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical Director is… more
- Humana (Harrisburg, PA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more