- Evolent (Harrisburg, PA)
- …with others. **Collaboration Opportunities:** + The Manager, Client Services oversees daily utilization management and directs the medical care of our members ... plans and serves in a supporting role to the Director, Intake and Utilization Management Operations. + This individual will not only lead a production team but… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- CVS Health (Harrisburg, PA)
- …and work schedules may include weekends, holidays, and evening hours_ As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... - 1+ years of clinical experience in acute or post-acute setting - Utilization management is a 24/7 operation. Work schedules will include a minimum of 6… more
- CVS Health (Harrisburg, PA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the operational areas of care management , ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- Humana (Harrisburg, PA)
- …part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical ... to work **1 company holiday in 2025** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Harrisburg, PA)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- UPMC (Pittsburgh, PA)
- …Advisors at each hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management (UM) across assigned hospitals, ... effectively with hospital administration and clinical teams. + Experience in utilization management and care coordination. + In-depth understanding of… more