• Regional Medical Director, Care Management…

    UPMC (Pittsburgh, PA)
    The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This role ... managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote adherence to URAC standards,… more
    UPMC (07/11/25)
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  • Utilization Review Assistant…

    St. Luke's University Health Network (Sellersville, PA)
    …we serve, regardless of a patient's ability to pay for health care. The Utilization Review (UR) Assistant manages and obtains all funding for inpatient clients ... at the St. Luke's Penn Foundation Inpatient Recovery Center. JOB DUTIES AND RESPONSIBILITIES: + Manages the day-to-day insurance and funding reviews for all inpatient clients. + Performs continued stay and discharge reviews when needed. + Performs… more
    St. Luke's University Health Network (08/08/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …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
    Wellpath (08/08/25)
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  • Utilization Management Nurse Consultant

    CVS Health (Harrisburg, PA)
    …in ER, Med/Surg, and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with MS office applications such ... heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management is a 24/7… more
    CVS Health (08/08/25)
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  • Director Financial Investigations & Provider…

    Highmark Health (Pittsburgh, PA)
    …and civil law related to insurance fraud and advances in the post-payment utilization review process + Comprehensive knowledge of legal and investigative ... execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and investigation… more
    Highmark Health (08/08/25)
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  • Medical Review Coordinator

    Prime Healthcare (Bristol, PA)
    …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... institution in a Health and Human Services field is highly preferred. 2. Utilization Review /Case Management experience is highly preferred. 3. 1+ year of… more
    Prime Healthcare (07/25/25)
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  • Medical Director - Utilization Management

    UPMC (Pittsburgh, PA)
    …Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including ... The Medical Director, Utilization Management is responsible for assuring physician commitment...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
    UPMC (06/12/25)
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  • Lead, Strategic Sourcing

    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
    UPMC (07/30/25)
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  • Remote Medical Director - Pennsylvania

    Centene Corporation (Harrisburg, PA)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
    Centene Corporation (06/07/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Harrisburg, PA)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
    Evolent (07/30/25)
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