- 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
- 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
- Humana (Harrisburg, PA)
- …support the design, implementation, and advancement of strategic initiatives within the Utilization Management (UM) function. This role is responsible for ... knowledge of industry regulations, accreditation standards, and emerging trends in utilization management . Support the organization's commitment to talent… 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 (Allentown, 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 (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
- CVS Health (Harrisburg, PA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… 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
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