- 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 ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- WellSpan Health (York, PA)
- …Required **Work Experience:** + 2 years Recent acute care experience. Required + Utilization management , case management , or clinical nursing specialty. ... year **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to… more
- Guthrie (Sayre, PA)
- …aspects for Care Coordination including, but not limited to Case Management , Utilization Review (UR), Utilization Management (UM), and Medical Social ... in and experience of payer contract language, as it relates to utilization management . Can navigate through the requirements imposed by all payers. Prior… more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... support continuous quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and the treatment team regarding the… more
- WellSpan Health (York, PA)
- …principles. **Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... support continuous quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and the treatment team regarding the… more
- Evolent (Harrisburg, PA)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Centene Corporation (Harrisburg, PA)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- WellSpan Health (Lebanon, PA)
- …data analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required, and ... participates on committees as requested. **Qualifications** **Minimum Education:** + Bachelors Degree Must be degreed in social work or social welfare per PA Act 68 of 2008. Required **Work Experience:** + Less than 1 year Relevant experience. Required… more
- WellSpan Health (Chambersburg, PA)
- …data analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required, and ... participates on committees as requested. **Qualifications** **Minimum Education:** + Bachelors Degree Must be degreed in social work or social welfare per PA Act 68 of 2008. Required **Work Experience:** + Less than 1 year Relevant experience. Required… more
- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use… more