- Guthrie (Troy, PA)
- …of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
- Evolent (Harrisburg, PA)
- …requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business ... and management staff as well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical audits for quality and… more
- UPMC (Media, PA)
- …Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network ... would join a highly educated and motivated team of physician advisors at CCBHO who advocate well for the...to Community Care members. + Focus on quality and utilization from a regional perspective to include UPMC Passavant… more
- Magellan Health Services (Somerset, PA)
- …Strong organization, time management and communication skills.* Knowledge of utilization management procedures, mental health and substance abuse community resources ... of DSM V or most current diagnostic edition.* Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …The ER Care manager will function as a liaison between attending physicians, Physician Advisors, local CCRCs, SNFs, PCFs, patients, families and community. The role ... of patient care needs. The ER Care Manager will assist in identifying physician and staff documentation opportunities to support Quality and Pay for Performance… more
- Guthrie (Sayre, PA)
- …aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social Work. ... knowledge in and experience of payer contract language, as it relates to utilization management. Can navigate through the requirements imposed by all payers. Prior… more
- Evolent (Harrisburg, PA)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve… more
- Evolent (Harrisburg, PA)
- …Medical Director, Physical Medicine and Rehab you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve… more
- Highmark Health (Pittsburgh, PA)
- …RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to ... Formularies by monitoring FDA-approvals and drug manufacturer pipelines, assessing drug utilization reports, and writing drug monographs for Pharmacy & Therapeutics… more
- Evolent (Harrisburg, PA)
- …As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** . Serve… more