- Guthrie (Troy, 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
- Highmark Health (Pittsburgh, PA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... clinical review and decisions including but not limited to: physician and member appeals, member or provider information/education. + Participate on… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Rehab you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,… more
- Guthrie (Sayre, PA)
- …operational aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical ... knowledge in and experience of payer contract language, as it relates to utilization management. Can navigate through the requirements imposed by all payers. Prior… more
- UPMC (Pittsburgh, PA)
- …while also considering outcomes of the programs. + Develop and conduct Drug Utilization Review (DUR) activities, Medication Therapy Management (MTM), and other ... and enhance clinical reporting programs, including but not limited to physician specific reporting, alternative prescribing programs for utilization , assigned… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more