- Humana (Harrisburg, PA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- WellSpan Health (Lebanon, 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
- WellSpan Health (York, PA)
- …**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
- Penn Medicine (Philadelphia, PA)
- …resource management , case management , social services, discharge planning, and utilization management to develop and implement methods to optimize use of ... * Possess or develop a solid foundation in the areas of utilization management and hospital operations (required) * Master of Business Administration (MBA),… more
- Highmark Health (Harrisburg, PA)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements… more
- Highmark Health (Harrisburg, PA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Wolters Kluwer (Philadelphia, PA)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + **Ongoing Utilization Management ** + Oversee and analyze customer utilization ... Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider… more
- UPMC (Pittsburgh, PA)
- …medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... policies of the Health Plan. Contributes to process improvement within the Utilization Management department. + Participates in activities to support policy… more
- Evolent (Harrisburg, PA)
- …Stay for the culture. **What You'll Be Doing:** Job Description **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
- Evolent (Harrisburg, PA)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
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