- UPMC (Pittsburgh, PA)
- …with 6-8 year of experience. + 3 years of experience in behavioral, clinical, utilization management , home care, discharge planning, and/or case management ... Coordinates care and services across the continuum of care with case management , physicians, pharmacy, behavioral health, and other providers or health plan… more
- Prime Therapeutics (Harrisburg, PA)
- …formularies, including items such as manufacturer and GPO negotiation, rate and utilization management policy creation and interpretation, formulary modeling and ... duties as assigned **Minimum Qualifications** + Bachelor's degree in business, healthcare management or other related field of study or equivalent combination of… more
- St. Luke's University Health Network (Lehighton, PA)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... BSN required or obtained within 3 years of hire, MSN and/or Case Management Certification preferred. TRAINING AND EXPERIENCE: Preference is for at least two years… more
- CVS Health (Harrisburg, PA)
- …Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license without ... provide oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers.… more
- Veterans Affairs, Veterans Health Administration (Butler, PA)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsible… more
- Wolters Kluwer (Harrisburg, PA)
- …including: + Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations + Overseeing contract ... + Closely managing the deal through closure and keeping management informed of any risks or delays + Retaining...level and other key decision makers + Excellent account management skills and ability to manage external and internal… more
- UPMC (Pittsburgh, PA)
- …work/human service field + Three years of experience in behavioral, clinical, utilization management , home care, discharge planning, and case management ... Coordinates care and services across the continuum of care with case management , physicians, pharmacy, behavioral health, and other providers or health plan… more
- WellSpan Health (York, PA)
- …in orthopedic or neuro nursing required + Previous quality assessment and utilization management experience preferred **Licenses:** + Licensed Registered Nurse ... identifying areas that require attention. Is responsible for all program management , report generation and review, process improvement, patient satisfaction and… more
- Penn State Health (Hershey, PA)
- … of processes. + Experience in Coding, Billing Denials, Edits, Appeals, Utilization Management , Charge Capture, Compliance/Revenue Cycle Auditing. **WHY PENN ... interaction with providers and operations. **PREFERRED QUALIFICATION(S):** + Previous management level experience in a healthcare setting applicable to revenue… more
- UPMC (Seven Fields, PA)
- …establish patients' plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians' orders and ... patients' needs. + RN will coordinate case management activities across a multi-disciplinary health care team to ensure appropriate, quality patient care. +… more