- Humana (Harrisburg, PA)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization,… more
- Defense Logistics Agency (Philadelphia, PA)
- …Analyzes and evaluates industrial facilities, equipment, operations, processes, manpower utilization , management systems, and other relevant aspects to ... and carries out plans for the expansion, conversion, integration and/or utilization of industrial production facilities to meet strategic or mobilization… more
- St. Luke's University Health Network (Quakertown, PA)
- …who may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and ... mental health/crisis intervention experience required. Previous experience with case management / utilization review and managed care models preferred. Please… more
- Humana (Harrisburg, PA)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Highmark Health (Harrisburg, PA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... data-driven insights from complex healthcare datasets (eg, claims, clinical, utilization , pharmaceutical) to inform policy development, identify areas for… more
- Elevance Health (Seven Fields, PA)
- …licenses upon hire. + Child and Adolescent board certification preferred. + Utilization management experience preferred. For candidates working in person or ... must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- WellSpan Health (Lewisburg, PA)
- …data analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required, and ... participates on committees as requested. **Qualifications** **Minimum Education:** + Bachelors Degree Must be degreed in social work or social welfare per PA Act 68 of 2008. Required **Work Experience:** + Less than 1 year Relevant experience. Required… more
- Highmark Health (Harrisburg, PA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Dollar Tree (Berwick, PA)
- …meet or exceed outbound key performance metrics including but not limited to fleet utilization , on time service, backhauls, and cost management . + Assists in the ... measuring, and improving key performance metrics in store service, carrier utilization , trailer management . + Manage third-party onsite Carrier Managers… more
- Prime Therapeutics (Harrisburg, PA)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract… more