• Medical Director

    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 (01/06/26)
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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 ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
    Evolent (12/18/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (01/08/26)
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  • Field Medical Director, 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 ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (12/31/25)
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  • RN Acute Case Manager - System Care Management…

    Guthrie (Sayre, PA)
    …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
    Guthrie (12/25/25)
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  • Field Medical Director, (Orthopedic Surgery)MSK…

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Surgery you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (01/09/26)
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  • Field Medical Director, Pain Management

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (12/25/25)
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  • Field Medical Director, Oncology

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (11/18/25)
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  • RN - Inpatient Case Manager (Daylight)

    Highmark Health (Jefferson Hills, PA)
    …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
    Highmark Health (01/07/26)
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  • RN Clinical Manager

    CenterWell (Lancaster, PA)
    …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review … more
    CenterWell (01/08/26)
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