- Elevance Health (Seven Fields, PA)
- …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 ... of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May...hire. + Child and Adolescent board certification preferred. + Utilization management experience preferred. For candidates working… more
- Highmark Health (Harrisburg, PA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more
- Humana (Harrisburg, PA)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… 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
- Sargent Electric (Pittsburgh, PA)
- …Timely decisions and direction to ensure project profitability. + The proper utilization / management of Company-Owned and rented equipment. + Direct supervision ... office. The primary responsibility of this position is the successful supervision and management of construction activities, in the safest manner possible, up to and… more
- Travelers Insurance Company (Harrisburg, PA)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
- Carnegie Mellon University (Pittsburgh, PA)
- …Provide analytical support and financial insight for audits, facilities projects, space utilization , grants management , and special projects. + Coordinate with ... + Coordinate with grant and contract accounting, including pre-award budget review , post-award expense tracking, effort reporting, and closeout. + Coordinate with… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... DME, placements, hospice, community resources, transportationQuality data collection and risk management referralWorks with patient and family to assure provision of… more
- Geisinger (Shamokin, PA)
- …all Revenue Management teams and departments including Practice Consultants, Utilization Management and Care Management , Providers, Geisinger ... and out surgeries and outpatient clinical departments. + Follows Revenue Management policies and procedures regarding financial matters and payment arrangements. +… more
- Evolent (Harrisburg, PA)
- …review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity… more