- AmeriHealth Caritas (Philadelphia, PA)
- …and their providers: + Identifying and implementing evidence-based practice guidelines throughout the provider network . + Overseeing the quality of clinical ... and non- network providers. + Engaging the provider network in Continuous Quality ...closely with a multidisciplinary team to ensure behavioral health management and quality management programs… more
- Highmark Health (Blue Bell, PA)
- …appropriately manage CMS audit risk. **ESSENTIAL RESPONSIBILITIES:** 1. Program Development and Management : + Provide strategic leadership and management for ... member's care. + Collaborate with key internal stakeholders (Clinical Services, Provider Transformation, Network Contracting, Actuarial, Finance and Compliance)… more
- Magellan Health Services (Somerset, PA)
- …activities which monitor established quality of care standards in the participating provider network and for care managers. + Conducts reviews of Quality ... reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following… more
- Highmark Health (Pittsburgh, PA)
- …administrative costs, and enhance the member experience. + ** Provider Network Management :** Develop and maintain a high- quality provider network ... of the Medicaid business, including member enrollment, claims processing, care management , and quality improvement. Implement best practices to streamline… more
- Catalent Pharma Solutions (Philadelphia, PA)
- …managing or completing tasks that support the Global Comparator and Depot Supplier Quality Management and Clinical Packaging Network site Supplier Programs. ... + Manage the approved supplier list for Global Supplier Quality and network supplier programs + Independently...in JDE and Trackwise systems preferred + Demonstrate project management skills with an ability to prioritize, plan, evaluate… more
- GAF (Harrisburg, PA)
- … Quality team is responsible for overseeing quality assurance, management , and enhancement initiatives throughout the supplier network (Residential and ... quality audit.* Lead the development, implementation, maintenance, and reporting of GAF Quality Management Systems within Supplier Quality .* Lead the… more
- Merck (Harrisburg, PA)
- …+ Ability to interpret and apply regulatory expectations to maintain a robust Quality Management System (QMS). **Core Competencies:** + **Drive Results:** Set ... IS Audit, Management Process, Manufacturing Processes, Pharmaceutical Manufacturing, Quality Improvement Programs, Quality Management , Quality… more
- UPMC (Pittsburgh, PA)
- …and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns. + Provide expedited review and determination ... developments in the areas of quality improvement and utilization management . + Communicate and educate network providers regarding clinical guidelines,… more
- Evolent (Harrisburg, PA)
- …Sophisticated knowledge of clinical operations in managed care, including quality management , outcomes, provider network , claims, financial management ... with other intake leaders across the organization, training and development, provider relations, member services, claims management and our implementation… more
- PCI Pharma Services (Philadelphia, PA)
- … Systems Manager** is responsible for overseeing and maintaining the Electronic Quality Management System (eQMS) to ensure compliance with regulatory ... tomorrow. Our strategy includes building teams across our global network to pioneer and shape the future of PCI....include the following but other duties may be assigned. ** Quality Management System Oversight** + Manage and… more