- UPMC (Pittsburgh, PA)
- …policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, ... standards and professional developments in the areas of quality improvement and utilization management . + Communicate and educate network providers regarding… more
- Magellan Health Services (Somerset, PA)
- …Strong organization, time management and communication skills.* Knowledge of utilization management procedures, mental health and substance abuse community ... Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community… more
- St. Luke's University Health Network (Allentown, PA)
- …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
- UPMC (Pittsburgh, PA)
- …+ Provide innovative and applicable ideas in clinical program development, utilization management , formulary management , provider education, therapeutic ... + Provide innovative ideas for new and existing clinical program development, utilization management , formulary management , provider education, and… more
- Evolent (Harrisburg, PA)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- Evolent (Harrisburg, PA)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent (Harrisburg, PA)
- …specialty match reviewer for Spine Surgery cases. 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
- 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
- CVS Health (Harrisburg, PA)
- …on outreach priorities based on service territory and capacity constraints + System Utilization & Workflow Management + Operate and maintain Salesforce Field ... day. We are seeking a proactive and highly organized Manager of Production Management to join the Signify Health team to oversee field service dispatch operations… more
- Highmark Health (Pittsburgh, PA)
- …leadership team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality ... . + Assists with appeal letters and participates in data collection activities for utilization management . + Receives daily report from Nursing Service (Bed … more