- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** To ensure the appropriate utilization of services act as an advocate for our members and to ensure the ... **Collaboration Opportunities** : As a Radiation Technologist in the Utilization Management department, you will work closely with other...medical necessity, the request is sent to a physician reviewer . At no time can a URN recommend an… more
- Evolent (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Prime Healthcare (Philadelphia, PA)
- …Organizations, the nation's oldest and largest hospital accreditation agency. Responsibilities The Utilization review tech essentially works to coordinate the ... utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls,… more
- Centene Corporation (Harrisburg, PA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... REMOTE/WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS BEHAVIORAL HEALTH UTILIZATION MANAGEMENT.** **APPLICANTS MUST EITHER HOLD AN ACTIVE PA LICENSURE;… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- UPMC (Pittsburgh, PA)
- …full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent, ... MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director, Utilization ...and potential quality of care concerns. + Provide expedited review and determination of medically pressing issues in accordance… more
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external… more
- CVS Health (Harrisburg, PA)
- …in a hospital setting required for either BH or RN -1+ years of utilization review / utilization management required (ie concurrent review , ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- Humana (Harrisburg, PA)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CenterWell (Harrisburg, PA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more