- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... setting **Preferred** + Experience in UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Penn Medicine (Lancaster, PA)
- …Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for ... under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical records to… more
- Cognizant (Harrisburg, PA)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' ... in health care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial… more
- Highmark Health (Harrisburg, PA)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **About this role** The Medical Director of Utilization Management leads and oversees utilization review, case ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
- CVS Health (Harrisburg, PA)
- …all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit ... solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other… more
- Prime Healthcare (Philadelphia, PA)
- …the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, ... Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely… more
- Guthrie (Sayre, PA)
- …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... hospital inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre ‐ determined criteria. b.… 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 ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more