• Medical Director - Utilization

    UPMC (Pittsburgh, PA)
    The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
    UPMC (06/12/25)
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  • Regional Medical Director, Care Management

    UPMC (Pittsburgh, PA)
    …Advisors at each hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management (UM) across assigned hospitals, ... effectively with hospital administration and clinical teams. + Experience in utilization management and care coordination. + In-depth understanding of… more
    UPMC (07/11/25)
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  • LPN Utilization Mgmt Reviewer - Medical…

    Guthrie (Troy, PA)
    Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... physician offices, and the Robert Packer Hospital Business Office,...Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of… more
    Guthrie (07/15/25)
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  • Clinical Resource Coordinator…

    Penn Medicine (Philadelphia, PA)
    …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... to share this rewarding and **REMOTE RN** role! This role will focus primarily on utilization review which is why we are seeking individuals who have between 3 to 5… more
    Penn Medicine (08/13/25)
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  • Medical Director, MSK Surgery

    Evolent (Harrisburg, PA)
    …reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business Managers to ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
    Evolent (05/20/25)
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  • Physician - Chief Vascular Surgery Section

    Veterans Affairs, Veterans Health Administration (Philadelphia, PA)
    …of care as an integral part of the overall Medical Center quality management program. This includes participation in medical center meetings, VISN meetings and ... students and residents within vascular services. Oversees Vascular specific time utilization to include appropriate prioritization of cases among all practitioners… more
    Veterans Affairs, Veterans Health Administration (08/10/25)
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  • Physician - PACE Kinder Park

    Trinity Health (Woodlyn, PA)
    **Employment Type:** Full time **Shift:** Day Shift **Description:** **Primary Care Physician ** Shift: Monday - Friday 8 am to 5:00 pm Status: Full time Location: ... the supervision of the medical director, the Primary Care physician (PCP) provides primary medical care to PACE Organization...of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your… more
    Trinity Health (08/03/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Sayre, PA)
    …healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care... through ongoing interaction with the patient and family/caregivers, physician and other health care providers to achieve designated… more
    Guthrie (07/17/25)
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  • Dir, Care Coord - System Care Management

    Guthrie (Sayre, PA)
    …aspects for Care Coordination including, but not limited to Case Management , Utilization Review (UR), Utilization Management (UM), and Medical Social ... of knowledge in and experience of payer contract language, as it relates to utilization management . Can navigate through the requirements imposed by all payers.… more
    Guthrie (07/14/25)
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  • Case Management Nurse-RN Weekend Option 3…

    WellSpan Health (York, PA)
    …Required **Work Experience:** + 2 years Recent acute care experience. Required + Utilization management , case management , or clinical nursing specialty. ... **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine...and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides… more
    WellSpan Health (07/22/25)
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