- UPMC (Pittsburgh, PA)
- …or Emergency Medicine Physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This ... choose their weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate … more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate … more
- AmeriHealth Caritas (Philadelphia, PA)
- …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the administrative tasks… more
- UPMC (Media, PA)
- …Behavioral Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical ... the provider network for the clinical needs of Community Care members. The Medical Director also participates in regional leadership policy decisions and… more
- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals, and potential quality of care concerns. +… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals, and potential quality of care concerns. +… more
- Elderwood (Philadelphia, PA)
- …nursing policies, procedures, and quality programs. + Partner with the Administrator and Medical Director to ensure compliance with federal, state, and local ... Overview Director of Nursing (RN) - Pediatric Specialty Care...Specialty Care? At PSC, we specialize in providing complex medical and rehabilitative care for medically fragile children. Our… more
- Spring Creek Rehabilitation and Nursing Center (Harrisburg, PA)
- Position: Assistant Director of Nursing (ADON) Spring Creek Rehab & Healthcare Center: Harrisburg, PA Spring Creek is currently looking for a full time Assistant ... Director of Nursing (ADON) to assist with leading our...residents served. + Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations,… more
- Highmark Health (Harrisburg, PA)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more