- Centene Corporation (Harrisburg, PA)
- …for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs ... medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services,… more
- UPMC (Pittsburgh, PA)
- …to UPMC Health Plan members. They oversee adherence to quality and utilization standards through committee delegations and further establish an effective working ... of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and… more
- Trinity Health (Darby, PA)
- …Part time **Shift:** **Description:** **RN Care Manager - Utilization Management** **Location:** Mercy Fitzgerald **Department:** Care Coordination **Schedule:** ... Purpose** Mercy Fitzgerald is seeking a dedicated **RN Care Manager - Utilization Management** to join our Care Coordination team. Under the general supervision… more
- Penn Medicine (Philadelphia, PA)
- …integrated health care, achieve clinically appropriate and financially sound resource utilization , support the insurance verification team, clinical staff and verify ... payer reimbursement.Asses clinical information for appropriateness of settling and utilization of resources to optimize patient outcomes and cost effective.Provide… more
- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more
- Magellan Health Services (Somerset, PA)
- …Strong organization, time management and communication skills.* Knowledge of utilization management procedures, mental health and substance abuse community resources ... of DSM V or most current diagnostic edition.* Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.… more
- Evolent (Harrisburg, PA)
- …As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- Magellan Health Services (Bethlehem, PA)
- …DSM V or most current diagnostic edition and ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care ... and other clinical team members through content knowledge, technical and utilization management expertise. Researches open questions and unresolved issues for Care… more
- Guthrie (Troy, PA)
- …for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal ... years of experience in an acute care setting with strong care management, utilization review, and payer knowledge. A Case Management certification or obtaining a… more
- Genesis Healthcare (Williamsport, PA)
- …delivery of the highest standard of rehabilitation services through appropriate utilization of resources, the promotion of clinical programs, and staff development ... oversight related to case management, quality improvement, care planning, clinical utilization , and patient identification is overseen by a licensed therapist.… more