• Medical Director - Utilization Management

    UPMC (Pittsburgh, PA)
    The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health ... care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working… more
    UPMC (06/12/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case management, quality ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external… more
    Wellpath (08/08/25)
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  • Regional Medical Director, Care Management…

    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 ... focuses on improving patient flow, resource utilization , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care… more
    UPMC (07/11/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Harrisburg, PA)
    …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more
    CVS Health (08/24/25)
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  • LPN Utilization Mgmt Reviewer - Medical…

    Guthrie (Troy, PA)
    Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
    Guthrie (07/15/25)
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  • Medical Director Utilization Management

    AmeriHealth Caritas (Philadelphia, PA)
    ; **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the operational areas of care management, utilization ... and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
    AmeriHealth Caritas (08/12/25)
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  • SNF Utilization Management RN - Compact Rqd

    Humana (Harrisburg, PA)
    …part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently… more
    Humana (08/09/25)
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  • Utilization Review Clinician - Behavioral…

    Centene Corporation (Harrisburg, PA)
    …discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families ... regrading BH utilization process + Interacts with BH healthcare providers as...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
    Centene Corporation (08/22/25)
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  • Long Term Services & Support Utilization

    AmeriHealth Caritas (Philadelphia, PA)
    …services. Discover more about us at www.amerihealthcaritas.com . **Responsibilities:** The Utilization Management Technician Sr. functions under the direction of the ... receipt of information, and /or records for prompt review and response. ;The Utilization Management Technician Sr. also performs the following: + Is responsible for… more
    AmeriHealth Caritas (08/21/25)
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  • RN Registered Nurse Utilization Management…

    Penn State Health (Hershey, PA)
    …for maintaining compliance with the CMS Conditions of Participation for Utilization Management. **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing or ... information._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - Utilization Management **Location**… more
    Penn State Health (08/20/25)
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