- 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
- YesCare Corp (Philadelphia, PA)
- …Engage in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review :** Participate actively in utilization review ... justifications for non-formulary medication requests when necessary. + **Resource Utilization :** Resolve patient care issues using in-house resources before… more
- Wellpath (Lemoyne, PA)
- …Nursing or Care Management Certification. + RN preferred. Experience + Previous utilization review and/or case management and pre-certification experience + ... role** The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director, Regional Medical Directors, and Site Leadership to… more
- Elevance Health (Seven Fields, PA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ensuring clinical integrity of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May provide clinical guidance… more
- Highmark Health (Harrisburg, PA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
- ChenMed (Philadelphia, PA)
- …assess and record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible ... work experience required + A minimum of one (1) year of utilization review and/or case management, home health, hospital discharge planning experience required +… more
- CVS Health (Harrisburg, PA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Humana (Harrisburg, PA)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Battelle Memorial Institute (Harrisburg, PA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more