- 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)
- …heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… 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
- CVS Health (Harrisburg, PA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Harrisburg, PA)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… 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
- Wellpath (Lemoyne, PA)
- …point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case management ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
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