- Lyric (Newtown Square, PA)
- …+ Familiarity with affordability, claims operations, payment integrity, utilization management, medical policy and/or benefit policy development. **PREFERRED ... QUALIFICATIONS** + Active or prior state medical license (if retired from practice). + Outstanding presentation skills with the ability to simplify complex concepts for diverse audiences. + Familiarity with AI methodologies for claims anomaly detection and… more
- CSL Behring (King Of Prussia, PA)
- …-Excellent Strategic Thinking skills -Significant experience in the application and utilization of portfolio management systems and software - - **About CSL ... Behring** CSL Behring is a global biotherapeutics leader driven by our promise to save lives. Focused on serving patients' needs by using the latest technologies, we discover, develop and deliver innovative therapies for people living with conditions in the… more
- 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
- 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
- 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
- CVS Health (Harrisburg, PA)
- …skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... opportunities to promote quality effectiveness of healthcare services and benefit utilization . - Consults and lends expertise to other internal and 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
- CVS Health (Harrisburg, PA)
- …to promote quality and effectiveness of healthcare services and benefit utilization .* Consult and lend expertise to other internal and external constituents ... in the coordination and administration of the utilization /benefit management function.* Meet set productivity and quality expectations as established by… more
- CVS Health (Harrisburg, PA)
- …opportunities to promote quality and effectiveness of healthcare services and benefit utilization . * Consult and lend expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. * Meet set productivity and quality expectations as established… more
