- Highmark Health (Harrisburg, PA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Harrisburg, PA)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- CVS Health (Harrisburg, PA)
- …all with heart, each and every day. **Position Summary-** + **Must have Independent Behavioral Health License in State of Residence** + **Can reside Anywhere USA** + ... thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider… more
- CVS Health (Harrisburg, PA)
- …Qualifications** + Crisis intervention skills preferred Managed care/ utilization review experience preferred + Case management and discharge planning ... experience preferred + Managed care/ utilization review experience preferred **Education** Masters Degree in Social Work or Counseling required **Anticipated… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... mental health illness. Previous experience in discharge planning and case management models preferred.Current Behavioral Health department program for… more
- Highmark Health (Pittsburgh, PA)
- …in planning/marketing strategy to ensure referral sources. + Participates in peer utilization and/or review and assists in coordination of related quality ... clients as assigned to assess urgency of client need and recommend appropriate management . Provides on call coverage to caseload and for staff coverage to assess… more
- Highmark Health (Harrisburg, PA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- WellSpan Health (Chambersburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation… more
- UPMC (Pittsburgh, PA)
- …The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... Are you a registered nurse with a background in utilization management ? UPMC Health Plan is looking...information obtained from interaction with members and providers. + Review and document clinical information from health care providers… more
- Highmark Health (Monroeville, PA)
- …to ensure inventory and supply spend accountability is established and monitored. Review inventory utilization data; audit inventory system information systems ... for the strategic implementation of supply chain initiatives and operational management throughout AHN hospitals and surgery centers. The Materials Manager will… more