- CenterWell (Harrisburg, PA)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Harrisburg, PA)
- …Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization ... us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments… more
- MSA, The Safety Company (Murrysville, PA)
- …pursue optimization of both cost of goods purchased and inventory availability through utilization of an organized approach that yields cost synergies, a focus on ... Purchase Document Management + Utilize ERP system to effectively review and release purchase orders for the purpose of...as effective freight use and spend. MSA Operating System Utilization + Apply the MSA Operating System to correctly… more
- Oracle (Harrisburg, PA)
- …are achieved, maintenances are performed with minimal risk, manage capacity utilization , address local maintenance requirements, and support technical projects. The ... responsibilities include change management, incident & event support, space utilization , efficiency upgrades, and general engineering support. Directors are expected… more
- ChenMed (Philadelphia, PA)
- …assess and record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible ... work experience required + A minimum of one (1) year of utilization review and/or case management, home health, hospital discharge planning experience required +… more
- Penn Medicine (Philadelphia, PA)
- …quality data collection and risk management referral. **Responsibilities:** + Utilization management activities: monitor appropriate use of internal resources, ... resources + Participates and drives accountability in daily interdisciplinary meetings + Utilization Management: + Adheres to guidelines to satisfy 3rd party payer… more
- Highmark Health (Harrisburg, PA)
- …Nurse Licensure Compact (eNLC) Preferred + Bachelor's Degree in Nursing + 1 year in Utilization Management or Utilization Review + 1 year in Case Management ... appeal activities to include but not limited to, clinical record review , composing comprehensive appeal letters and compiling minimum necessary documentation to… more
- CSL Behring (King Of Prussia, PA)
- …provider levels. + Secures meetings with appropriate customer personnel to review the clinical and reimbursement information and adopt appropriate treatment ... with business teams, marketing and medical affairs to ensure alignment and full utilization of resources at account level. This includes utilization of marketing… more