- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring ... determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care… more
- CVS Health (Harrisburg, PA)
- …do it 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...treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and lends expertise to other… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring ... timely engagement of case management of all transplant members. Conduct utilization management reviews for all transplant services by assessing medical necessity,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Documents date that the request was received, nature of the request, utilization determination (and events leading up to the determination). Verifies and documents ... providers and appropriate others to facilitate and coordinate the Utilization Management process(es) activities. Utilize technology and resources (systems,… 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. UMNC meets set productivity and quality expectations. Effective… more
- Wolters Kluwer (Philadelphia, PA)
- …Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider ... are established and strengthened, drive product adoption and ensure utilization goals are achieved to maximize value realization, implementation projects… more
- Daiichi Sankyo, Inc. (Philadelphia, PA)
- …strong, long-term relationships with clinical personnelEnsures appropriate and compliant utilization of product and disease state education as it relates ... to DSI products.Executes disease state educational presentations and on label product safety presentations for in-office/in-hospital educational programs to customers that are guided and designed to address clinical knowledge or product gaps.Must be able to… more
- RxBenefits (Philadelphia, PA)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . Be the SME on dozens of medical vendor/PBM contracts including … more
- Owens & Minor (Pittsburgh, PA)
- …running reports, inventory management, and maintaining the usage history to improve a product utilization . We are looking for an individual who is able to commute to ... Department by providing product information for monitoring, controlling, and tracking utilization trends. Utilize QSight to provide management reports necessary to… more
- UPMC (Pittsburgh, PA)
- …service line steering teams and specialty sub-committees. Responsibilities Consulting/ Utilization Analysis Lead and coordinate respective sourcing team activities. ... edits communications and clinical literature research to support product utilization , product conversions and additions, trials and committee activities. Monitors,… more
