- UPMC (Pittsburgh, PA)
- …is seeking a licensed MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, Utilization Management is responsible for ... UPMC Health Plan members. They will oversee adherence to quality and utilization standards through committee delegations and further establish an effective working… more
- Prime Healthcare (Philadelphia, PA)
- …the nation's oldest and largest hospital accreditation agency. Responsibilities The Utilization review tech essentially works to coordinate the utilization ... review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking… more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary** This Registered Nurse Utilization Management position is an exciting opportunity to join a growing Aetna ... review stays. **Primary Job Duties & Responsibilities** Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of… more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to coordinate, document, ... and communicate all aspects of the utilization /benefit management program. **Job duties include (but are not limited to):** + Applies critical thinking and knowledge… more
- 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
- CVS Health (Harrisburg, PA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization * Consults and lends expertise to other internal and external… more
- Humana (Harrisburg, PA)
- …and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management 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 (Harrisburg, PA)
- …part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently… more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity ... **1 company holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Centene Corporation (Harrisburg, PA)
- …and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss ... + Provides education to members and their families regrading ABA and BH utilization process + Provides feedback to leadership on opportunities to improve care… more