- Geisinger (Lewistown, PA)
- …with the goal of optimizing the patient or member's health status. + Manages utilization and practice metrics to further refine the delivery of care model to ... coordination of services. + Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency… more
- Insight Global (York, PA)
- …equipment. Machines will have multiple pallets to maximize efficiency & increase machine utilization . Operators will load pallets & deburr while machine is in cycle ... to maximize utilization . Our client is a specialized team serving as...of available jobs and pallet stations to maximize machine utilization , managing the machines automatic tool changer systems, equipped… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Select Medical (York, PA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial ... patient specific, safe and timely discharge plan. + Performs verification of utilization criteria reviews. + Builds relationships and coordinate with payor sources… more
- CDR Maguire (Allentown, PA)
- …they coincide with current workload, backlog, strategic direction of firm, and utilization metrics for the Division. + Address operating issues as needed including ... appropriate follow up of accounts receivables, accounts payables, WIP, and utilization . + Effectively manage staff including allocation of production staff,… more
- UPMC (Pittsburgh, PA)
- …healthy lifestyles, closes gaps in care, reduces unnecessary ER utilization and hospital admissions/readmissions, and manages social determinants of health. ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of care… more
- Sedgwick (Harrisburg, PA)
- …use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, trends, and ... include three (3) years of recent clinical practice experience. Utilization practice experience preferred. Insurance/claims industry experience preferred. **Skills &… 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 (Monroeville, PA)
- …that supports excellence of care and achievement of optimal resource utilization . Also facilitates appropriate LOS, patient satisfaction and reimbursement for all ... a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.… more
- Evolent (Harrisburg, PA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.… more