- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more
- University of Pennsylvania (Philadelphia, PA)
- …all correspondence, written materials, documents are prepared in timely manner for review and distribution to meet all deadlines. Also ensures that all documents ... program for each fiscal year, including requests for applications, utilization of databases; application processing, recruitment, interviews, fellow selection,… more
- Humana (Harrisburg, PA)
- …Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, ... Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard weekends… more
- Highmark Health (Harrisburg, PA)
- …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... Participate in product specific government meetings as necessary. + Coordinate implementation of clinical programs and operational requirements as necessary. + Support product specific business retention and business development activities as necessary. +… more
- Carnegie Mellon University (Pittsburgh, PA)
- …+ Coordinate with grant and contract accounting, including pre-award budget review , post-award expense tracking, effort reporting, and closeout. + Coordinate with ... for financial planning, forecasting, and scenario analysis. + Assess resource utilization and staffing models to align operations with evolving organizational needs.… 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
- Globus Medical, Inc. (Audubon, PA)
- …inventory is required to support surgical cases, ensuring coverage and efficient asset utilization . + Review and process Loaner Extension Requests. + Coordinate ... support proper allocation to meet case demands. + Maximize consignment inventory utilization in line with Scorecard goals. + Support management of company inventory… more
- St. Luke's University Health Network (Sellersville, PA)
- …mental health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and consults.… more
- Humana (Harrisburg, PA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be… more