- UPMC (Pittsburgh, PA)
- …service line steering teams and specialty sub-committees. Responsibilities: + Consulting/ Utilization Analysis + Lead and coordinate respective sourcing team ... and edits communications and clinical literature research to support product utilization , product conversions and additions, trials and committee activities. +… more
- UPMC (Pittsburgh, PA)
- …of the day-to-day operations of the authorization, denial management, and/or utilization review functions of UPMC Revenue Cycle, involving both clinical and ... + Function as a resource person for authorization, denial management and/or utilization review processes. + Assess and respond to organizational and customer needs… more
- Sysco (Harmony, PA)
- …Levels and works with site leadership to ensure work method and system utilization and compliance + Works with site leadership to improve overall warehousing ... and optimal slotting configurations. + Works with site leadership to ensure optimal utilization of Roadnet and ensure proper routing practices and policies are being… more
- UPMC (Murrysville, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care following… more
- UPMC (Pittsburgh, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care following… more
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Penn Medicine (Philadelphia, PA)
- …with healthcare professionals, IT teams, and vendors to ensure the effective utilization of clinical systems to support patient care and improve operational ... professionals, IT teams, and vendors to ensure the effective utilization of clinical systems to support patient care and...professionals, IT teams, and vendors to ensure the effective utilization of clinical systems to support patient care and… more
- Humana (Harrisburg, PA)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- YesCare Corp (Philadelphia, PA)
- …justifications for non-formulary medication requests when necessary. + **Resource Utilization :** Resolve patient care issues using in-house resources before ... in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review:** Participate actively in utilization review processes,… more
- Evolent (Harrisburg, PA)
- …Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical record… more