- Evolent (Harrisburg, PA)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... utilization, and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice...Collaboration + Serve as a liaison and consultant for internal UM functions, promoting effective communication and… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as… more
- CVS Health (Harrisburg, PA)
- …Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...UM (Utilization Management) experience *Active and current state medical license without encumbrances *M.D. or DO, Board Certification… more
- The Cigna Group (Philadelphia, PA)
- …solutions. **Essential Functions:** + Ability to manage development and execution of clinical UM strategy. This would include both the ongoing updates to existing ... UM solutions and the evolution of UM ...to drive efficient communication of asks and the resulting internal stakeholder evaluation of newly obtained contracted rates and/or… more
- AmeriHealth Caritas (Philadelphia, PA)
- …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide ... LTSS and other systems/vendors as needed + Collaboration with internal counterparts as needed to ensure proper handling of...needed to ensure proper handling of the appeal eg UM team, medical directors, claims, contact center,… more
- Highmark Health (Wexford, PA)
- …) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within the context of the request, ... (15%) + Responsible for all preauthorization entries into applicable databases (ie internal medical claims systems, PBM pharmacy systems) to ensure swift… more