- Healthfirst (PA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... hospice, community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management … more
- AmeriHealth Caritas (Newtown Square, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Select Medical (Mckeesport, PA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager (PRN)** _Requires a current licensure in a...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Performance Food Group (Wilkes Barre, PA)
- …Coordinates pick planning in conjunction with the Warehouse Manager . + Utilization of Company's warehouse management system and other technologies available ... candidate should possess:** + Strong knowledge of warehouse procedures, inventory management , and material handling equipment. + Experience with inventory … more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and... of resources to the attention of the appropriate manager (s). **Common Expectations:** + Demonstrates a commitment to patient,… more
- WellSpan Health (Ephrata, PA)
- …to staff regarding case management , discharge planning, social services and utilization management . Provides input into the budget management of ... barriers for staff. **Common Expectations:** + Demonstrates knowledge of case management , utilization review and population health. Assesses and interprets… more
- ChenMed (Philadelphia, PA)
- …rapidly expanding and we need great people to join our team. The RN Case Manager (Community Care Nurse) is an on-site role within our Primary Care office and is ... post-acute facilities, as well as, their home environments. The Nurse Case Manager role also involves establishing relationships with patients' families and care… more
- St. Luke's University Health Network (Allentown, PA)
- …patient's ability to pay for health care. The IT Vendor and Contracts Manager leads IT's Vendor/Contact Management Office (VCMO). Responsibilities include but ... and attainment, reporting and governance. At an operational level, the Manager directs contract consultations and negotiations, including contract reviews, analysis,… more