- 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
- 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
- Select Medical (Erie, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management and financial… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of… more
- Highmark Health (Harrisburg, PA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- PPL Corporation (Allentown, PA)
- …and facilities space utilization . + Coordinates the maintenance and utilization of Facilities Management 's specific information system's needs, such as ... capital construction program for buildings. + Coordinates the acquisition and utilization of services for construction management , general constructions, and… more
- Geisinger (Danville, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful...of optimizing the patient or member's health status. Manages utilization and practice metrics to further refine the delivery… more
- Evolent (Harrisburg, PA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- St. Luke's University Health Network (Sellersville, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. . Facilitates communication among all ... discharge interventions accordingly. . Actively addresses and monitors resource utilization and documents delays as appropriate. . Identifies patients with… more
- St. Luke's University Health Network (Bethlehem, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... discharge interventions accordingly. + Actively addresses and monitors resource utilization and documents delays as appropriate. + Identifies patients with… more