- Republic Services (Scottdale, PA)
- …and monitor all required testing, including sampling of monitoring wells; monitors utilization of cover material; review soil reports and provide information ... to Environmental Manager. + Monitor and control all liquid and/or gas extraction systems on or around the landfill site. + Manage relationship with all outside contractors. + Establish productivity goals where needed; ensure adherence to operating standards;… more
- World Insurance Associates, LLC. (Philadelphia, PA)
- …care reform, HIPAA). + Lead the delivery of enrollment, benchmarking, financial and utilization data based on financial review standards and make recommendations ... knowledge of plan design alternatives, underwriting and funding concepts. + Drive utilization and ensure accuracy of all agency management system information for… more
- The Cigna Group (Philadelphia, PA)
- …and oversight for all medical management functions, including case management (CM), utilization management (UM), and escalated case review . Ensures policies, ... plan environments, including fluency in medical management functions such as utilization management (UM), case management (CM), policy development, and governance.… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... customer service to Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand in hand with a licensed pharmacist… more
- RxBenefits (Philadelphia, PA)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- BriteLife Recovery (Hanover, PA)
- …+ Under the direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries, limit ... setting for behavior, and develop therapeutic relations with clients. + Assist in monitoring the therapeutic activities with patients, assist other team members as needed. + Work directly with the clients and provide proper recovery support. What we need from… more
- BriteLife Recovery (Hanover, PA)
- …functions. + Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries, ... limit setting for behavior, and develop therapeutic relations with clients. + Assists in monitoring the therapeutic activities with patients., assist other team members as needed. + Work directly with the clients and provide proper recovery support. + Special… more
- UPMC (Pittsburgh, PA)
- …face-to-face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral, pharmaceutical, and social needs of ... the member, including instrumental activities of daily living. Review UPMC Health Plan data and EMR data, and documentation in the member's electronic health records… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more