- 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
- Evolent (Harrisburg, PA)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more
- Veterans Affairs, Veterans Health Administration (Aspinwall, PA)
- …life cycle which includes planning, requirement determination, procurement, maintenance/upgrade, management utilization and disposal, Performs other related ... Supply Chain Officer (ACSCO) is a senior supply chain management (SCM) officer for the Pittsburgh VA Health Care...for from the receipt of title to the final utilization and disposal, Planning, developing, and adapting procedures to… more
- St. Luke's University Health Network (Quakertown, 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
- Geisinger (Wilkes-Barre, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... services with the goal of optimizing the patient or member's health status. Manages utilization and practice metrics to further refine the delivery of care model to… more
- Evolent (Harrisburg, PA)
- …Doing:** As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… 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 ... residence.** 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
- 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
- Penn Medicine (Philadelphia, PA)
- …skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician ... hospice, community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management … more
- Highmark Health (Harrisburg, PA)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files,… more