- 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
- 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
- RailWorks (Philadelphia, PA)
- …and equipment utilization monthly and report to management to maximize equipment utilization . * Review fuel reports, investigate fraud and abuse alerts * ... Review speeding and harsh driving reports and alert management of abuse * Review and monitor vehicle registrations, inspections and distribute insurance cards. *… more
- UPMC (Pittsburgh, PA)
- …RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... most appropriate setting and cost - effective manner. **Responsibilities:** + Review and document clinical information from health care providers including clinical… more
- Highmark Health (Harrisburg, PA)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- CVS Health (Harrisburg, PA)
- …Counselor) **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- CVS Health (Harrisburg, PA)
- …CISM experience. + Human Resource and/or Supervisory experience. + Case management, Utilization Review , or Utilization Management background preferred. ... **Education** + Master's degree in behavioral health field. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $54,095.00 - $155,538.00 This pay range represents the base hourly rate or base annual… more
- Evolent (Harrisburg, PA)
- …to adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures ... **What You Will Be Doing:** + Responsible for oversight of utilization management (UM)/care management (CM) correspondence development, internal and external… more
- Penn Medicine (Lancaster, PA)
- …Pennsylvania Board of Nursing. + Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care. + Care management experience in a managed ... Coordinates care across the continuum inpatient outpatient community to assure appropriate utilization of clinical and community resources. + Oversees and guides the… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more