- UPMC (Pittsburgh, PA)
- UPMC Health Plan is looking for Pharmacy Clinical Review Specialist I positions in the Pharmacy Services department. This is a full time position working Monday ... through Friday 11:30am to 8:00pm and weekend rotations. The Clinical Review Specialist will oversee administrative and system processes that relate to pharmacy prior… more
- UPMC (Bridgeville, PA)
- UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! This position provides prescription data entry and ... customer service to Rx Partners Skilled nursing and Hospice clients. The clinical review specialist at Rx Partners works hand in hand with a licensed pharmacist… more
- UPMC (Pittsburgh, PA)
- …of medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... mentoring the clinical team and providing product specific guidance to Quality, Utilization and Care Management, and Population Health. + Participate in the creation… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Review Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and ... of new and/or revised work processes, policies and procedures relating to LTSS Utilization Review . + Accurately answers questions regarding CHC benefits for… 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 ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
- RxBenefits (Philadelphia, PA)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- Highmark Health (Jefferson Hills, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- Penn Medicine (Lancaster, PA)
- …license and daily access to an insured vehicle. Preferred Qualifications + Knowledge of Utilization review or managed care + Experience with home visits + ... using care management platform/analytics. + Analyzes data to identify under/over utilization ; improve resource consumption; promotes potential reduction in cost and… 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 ... and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review … 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 ... and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review … more