- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This role ... between managed care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote adherence to URAC… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Insight Global (Philadelphia, PA)
- …a hospital or other health care setting. Prior discharge planning and/or utilization management experience is desirable. Performs utilization management for ... to evaluate discharge planning needs. Collaborates with hospital case management staff, physician and family to determine alternative setting at times and provide… more
- Highmark Health (Pittsburgh, PA)
- …team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality and throughput ... on case management and observation services on the bi-weekly Throughput Meeting. + The Physician Advisor needs to be able to review and analyze metric reporting… more
- YesCare Corp (Philadelphia, PA)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Other duties as ... Below is a list of your responsibilities as a ** Physician ** with YesCare at Curran Fromhold Correctional Facility. We...in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as… more
- Highmark Health (Harrisburg, PA)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in… more
- Evolent (Harrisburg, PA)
- …center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- 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
- Evolent (Harrisburg, PA)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- UPMC (Pittsburgh, PA)
- …policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, ... **Purpose:** The UPMC Health Plan is seeking a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC… more
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