- Healthfirst (PA)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient ... Utilization Management is also responsible for efficient utilization of health services and optimal health outcomes for… more
- UPMC (Media, PA)
- …Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network ... to Community Care members. + Focus on quality and utilization from a regional perspective to include UPMC Passavant...MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. +… more
- Evolent (Harrisburg, PA)
- …Doing:** Job Description As a FMD, Radiology 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
- Centene Corporation (Harrisburg, PA)
- …issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization . + Serve as primary contact for providers and act as a ... in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization , etc. + Completes special projects as assigned + Ability to travel… more
- Evolent (Harrisburg, PA)
- …: Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power ... years of analytics & reporting experience in healthcare, including medical economics, cost/ utilization analysis, and membership trend reporting. + 2+ years of SQL… more
- Magellan Health Services (Newtown, PA)
- …collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or ... outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coordination. Provides member assistance with mental… more
- Guthrie (Sayre, PA)
- …aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social Work. ... knowledge in and experience of payer contract language, as it relates to utilization management. Can navigate through the requirements imposed by all payers. Prior… more
- Highmark Health (Harrisburg, PA)
- …pharmacy strategies and other pharmacy strategy teams to execute on the formulary/ utilization (UM) and other strategic pharmacy products. This job will be ... with the goal of lowering care costs associated with the Organization's drug utilization across both the pharmacy as well as the medical benefits. This job… more
- Highmark Health (Pittsburgh, PA)
- …RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to ... Formularies by monitoring FDA-approvals and drug manufacturer pipelines, assessing drug utilization reports, and writing drug monographs for Pharmacy & Therapeutics… more
- Evolent (Harrisburg, PA)
- …As a Field Medical Director, Oncology, 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