- Evolent (Harrisburg, PA)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
- Penn Medicine (Lancaster, PA)
- …without reasonable accommodation to perform the following duties:** + Complete chart review and communicate patient status medical needs with insurance companies ... standards of medical practice; insurance benefit structures and related legal medical issues. + Knowledge of utilization management and quality improvement… more
- Highmark Health (Harrisburg, PA)
- …by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the ... determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by… more
- Penn Medicine (Philadelphia, PA)
- …through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor shall ... matters regarding physician practice patterns, over and under- utilization of resources, medical necessity, levels of...payer rules including CMS rules as it pertains to utilization review * Recommend and request additional… more
- YesCare Corp (Philadelphia, PA)
- …Engage in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review :** Participate actively in utilization review ... daily when applicable, ensuring timely and accurate documentation in patients' medical records. + **On-Call Support** : Provide on-call services as required… more
- R1 RCM (Jenkintown, PA)
- …transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise ... sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Physician Advisor** , you will help our client facilities navigate the… more
- Centene Corporation (Harrisburg, PA)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- UPMC (Pittsburgh, PA)
- … Director, Utilization Management role. The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of ... policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- UPMC (Pittsburgh, PA)
- … medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... to the CMO of Government Products, the AVP, Medicare Medical Services serves as one of the strategic and...clinical team and providing product specific guidance to Quality, Utilization and Care Management, and Population Health. + Participate… 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 ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more