- 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
- City of Pittsburgh (Pittsburgh, PA)
- …be required. Position Specific Duties: In addition to the position duties, the Development Review Planner also: + Checks applications for Basic Zoning Review and ... completeness. + Manages all aspects of the Basic Zoning Review and Site Plan Review processes to...land use, equity, sustainability, transportation, natural resources, housing, and utilization of resources. + Plans, manages, and directs or… more
- Fresenius Medical Center (Philadelphia, PA)
- …determining project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global ... the consolidation, analysis and reporting of commercial revenue. Develops standards of review and analysis to facilitate accurate and timely analysis of all… more
- Sunrise Senior Living (West Chester, PA)
- …key to achieving customer engagement. + Lead the development and regular review of the engagement improvement plan. + Resolve customer concerns effectively through ... delivery and institute and ensure corrective action in a timely manner. + Review customer and secret shopper surveys and act accordingly by instituting appropriate… more