- Evolent (Harrisburg, PA)
- …with others. **Collaboration Opportunities:** + The Manager, Client Services oversees daily utilization management and directs the medical care of our members on ... health plans and serves in a supporting role to the Director, Intake and Utilization Management Operations. + This individual will not only lead a production team… more
- 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
- CVS Health (Harrisburg, PA)
- …work schedules may include weekends, holidays, and evening hours_ As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in a collaborative process to assess,… 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
- 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
- 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
- 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
- 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 ... work **1 company holiday in 2025** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- 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
- 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