• 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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  • 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 (10/10/25)
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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- (MD/DO)

    Evolent (Harrisburg, PA)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology 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 (12/26/25)
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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 - Jefferson - Sign…

    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 (12/12/25)
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  • Clinical Manager, Revenue Cycle CCM

    UPMC (Pittsburgh, PA)
    …oversight of the day-to-day operations of the authorization, denial management, and/or utilization review functions of UPMC Revenue Cycle, involving both ... + Function as a resource person for authorization, denial management and/or utilization review processes. + Assess and respond to organizational and… more
    UPMC (12/30/25)
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  • RN Case Manager (Part Time) - West Penn Hospital

    Highmark Health (Pittsburgh, PA)
    …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies,… more
    Highmark Health (12/13/25)
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  • Clinical Case Manager Behavioral Health (Spanish…

    CVS Health (Harrisburg, PA)
    …and English **Preferred 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… more
    CVS Health (11/14/25)
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