- Evolent (Harrisburg, PA)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
- Penn Medicine (Lancaster, PA)
- …Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical records to… more
- Highmark Health (Harrisburg, PA)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... the physician against medical policy criteria. The incumbent then uses...prior authorization or appeals against medical policy through the Utilization Review system. Update the system records… more
- Penn Medicine (Philadelphia, PA)
- …through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor shall ... goals and objectives for assuring the effective and efficient utilization of health care services. The Physician ...payer rules including CMS rules as it pertains to utilization review * Recommend and request additional… 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
- R1 RCM (Jenkintown, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Physician Advisor** , you will help our client facilities navigate the ... to compliant revenue by reviewing payor peer-to-peer cases. Every day you will review cases for which authorization has been denied evaluating if the proper… 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
- UPMC (Pittsburgh, PA)
- …remote Medical Director, Utilization Management role. The Medical Director, Utilization Management is responsible for assuring physician commitment and ... policies of the Health Plan. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… 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
- 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 ... of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and… more