- Delaware Valley Community Health (Philadelphia, PA)
- …characteristics, ability to communicate, chronic illnesses and comorbidities, high ER utilization , developmental status or financial status. The position is also ... administrative capacity with regard to health center operations, chart review , and required reporting requirements. DVCH is an EOE/Veterans/Disabled/LGBTQ+ employer.… more
- Jazz Pharmaceuticals (Philadelphia, PA)
- …team to contribute and co-lead cross-functional Team Meetings and National Business Review meetings, which serve as a strategic platform to share market insights ... advanced analyses as required for brand performance assessment/management Evaluate product utilization data (internal and external) at the national level to reveal… more
- Prime Healthcare (Philadelphia, PA)
- …Organizations, the nation's oldest and largest hospital accreditation agency. Responsibilities The Utilization review tech essentially works to coordinate the ... utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls,… more
- Wellpath (Lemoyne, PA)
- …role** The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Humana (Harrisburg, PA)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Highmark Health (Harrisburg, PA)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Penn Medicine (Philadelphia, PA)
- …the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor ... changes in payer rules including CMS rules as it pertains to utilization review * Recommend and request additional and more complete medical record documentation… more
- UPMC (Pittsburgh, PA)
- …for various clinical and non-clinical disciplines across UPMC, including regular utilization review , spend analysis, product introductions and trials. + ... Supports clinical specialty committees focused on product introductions, value analysis and utilization review consistent with UPMC policies and procedures. +… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
