- Evolent (Harrisburg, PA)
- …As a Vascular Surgery, 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
- Highmark Health (Jefferson Hills, PA)
- …outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions, ... length of stay, ED utilization , and patient/family satisfaction. **ESSENTIAL RESPONSIBILITIES:** + Contributes to or completes comprehensive assessment of patients… more
- Penn Medicine (Lancaster, PA)
- …using care management platform/analytics. + Analyzes data to identify under/over utilization ; improve resource consumption; promotes potential reduction in cost and ... predictive analytics, risk stratification, cost-benefit analysis, financial analysis, clinical outcomes, utilization and practice patterns. + As RN primary role of… more
- Magellan Health Services (Morrisville, 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
- Evolent (Harrisburg, PA)
- …visualization, this role will collaborate cross-functionally to influence the effective utilization of data to deliver actionable insights, drive recommendations and ... of analytics & reporting experience in healthcare, including medical economics, cost/ utilization analysis, and membership trend reporting. + 5+ years of experience… more
- CVS Health (Pittsburgh, PA)
- …will be responsible for overseeing the development, maintenance, and execution of utilization management programs. This will include both the clinical content of the ... to ensure the programs are implemented correctly. Knowledge of utilization management interventions including prior authorization, step therapy, quantity limits,… more
- Evolent (Harrisburg, PA)
- …Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … 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
- AmeriHealth Caritas (Philadelphia, PA)
- …. **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management, this position is responsible for providing daily oversight of ... Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational support… more
- Penn Medicine (Philadelphia, PA)
- …Contract Manager collects and conducts analysis of spend data and other utilization data to identify expense reduction and operational improvement opportunities as ... UPHS departments + Analytics/Planning: + Reviews and analyzes supply trends and utilization , and recommends purchasing practice changes to ensure lowest price paid.… more