- Geisinger (Lewistown, 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
- Highmark Health (Harrisburg, PA)
- …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... experience in a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with claims data… more
- The Cigna Group (Philadelphia, PA)
- …leadership and oversight for all medical management functions, including case management (CM), utilization management (UM), and escalated case review. ... operating within health plan environments, including fluency in medical management functions such as utilization management (UM), case management (CM),… more
- UPMC (Pittsburgh, PA)
- …the CMA's collaborations, practical comprehension and hands-on experience in clinical care/ utilization management will result by collecting and assisting with ... + Assist clinical team with scheduling transportation, scheduling appointments, and tracking utilization . + Refer members to appropriate case management , health … more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resources + Participates and drives accountability in daily interdisciplinary meetings Utilization Management : + Adheres to guidelines to satisfy 3rd… 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
- Highmark Health (Harrisburg, PA)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- CVS Health (Harrisburg, PA)
- …- 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS Office suites - Must ... year - Occasional travel less than 5% to complete audits/meetings - Utilization Management is a 24/7 operation and work schedules will include weekends,… more
- Humana (Harrisburg, PA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , or similar activities **Preferred ... industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management… more
- St. Luke's University Health Network (Allentown, PA)
- …in order to facilitate a positive outcome for patients. + Assists in the utilization management of psychiatric patients. + Maintains clinical records of all ... + Provides case management duties as assigned by Supervisor. Case Management duties include individual assessments, utilization reviews, family or support… more