- UPMC (Media, PA)
- …care delivered to Community Care members. This includes significant responsibility for quality management and utilization management and for assuring the ... PH MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. + Acts as a liaison for Community Care… more
- Healthfirst (PA)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, ... and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services and optimal… more
- CVS Health (Harrisburg, PA)
- …o Consulting with and recommending standard and custom formulary options and utilization management edits. o Collaborating with internal partners to develop ... value and drives lowest net cost. o Consulting with and recommending utilization management programs or other clinical programs to a client. o Consulting with… more
- Highmark Health (Harrisburg, PA)
- …managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan. + ... pharmacy strategies and other pharmacy strategy teams to execute on the formulary/ utilization (UM) and other strategic pharmacy products. This job will be… more
- Highmark Health (Pittsburgh, PA)
- …Therapeutics Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior ... account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and disease management initiatives.… more
- Centene Corporation (Harrisburg, PA)
- …or medical group experience, provider relations, quality improvement, claims, contracting utilization management , or clinical operations. Project management ... align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in… more
- Evolent (Harrisburg, PA)
- …Doing:** Job Description As a FMD, Radiology 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)
- …Doing:** As a Field Medical Director, Oncology, 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
- UPMC (Washington, PA)
- …care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and ... The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the following… more
- Genesis Healthcare (York, PA)
- …to seven years of clinical nursing experience is required. Prior experience in utilization review, case management or discharge planning is required. Prior ... impact in the communities we serve. Responsibilities The Manager, Case Management is responsible for the clinical, administrative, and financial oversight of… more