- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... between managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote adherence to URAC… 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 ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Highmark Health (Pittsburgh, PA)
- …team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality and throughput ... Vice President of Care Continuum and Transitions and the Medical Director of Physician Advisors. **Duties:** +...observation services on the bi-weekly Throughput Meeting. + The Physician Advisor needs to be able to review… more
- YesCare Corp (Philadelphia, PA)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Other duties as ... **Experience & Requirements** + Graduate of an accredited medical school. + Fully licensed to practice medicine...Below is a list of your responsibilities as a ** Physician ** with YesCare at Curran Fromhold Correctional Facility. We… more
- Evolent (Harrisburg, PA)
- …center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… 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
- Evolent (Harrisburg, PA)
- …education and findings with matrixed Physician Business Manager. + Provides medical direction to the support services review process. Responsible for the ... of the Medical leadership team, providing timely medical review of service requests. Oversees the...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician… more
- UPMC (Pittsburgh, PA)
- **Purpose:** The UPMC Health Plan is seeking a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with ... to choose their weekly availability within the aforementioned time frame. The Medical Director, Grievances is responsible for assuring physician commitment and… 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
- Guthrie (Troy, PA)
- …healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and ... years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining… more
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