- AmeriHealth Caritas (Newtown Square, PA)
- …administrative services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Medical Director , Utilization Management ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, … more
- Wellpath (Lemoyne, PA)
- …and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- The Cigna Group (Philadelphia, PA)
- **Overall** Responsible for leading clinical strategy development and product management for pharmacy utilization management and the coordination of rebate ... contracting efforts to ensure alignment across formulary, utilization management , SafeGuard, and other trend solutions. **Essential Functions:** + Ability to… more
- YesCare Corp (Philadelphia, PA)
- …or as requested by management . + In conjunction with the Regional Medical Director provide psychiatric leadership for the utilization management ... is a list of your responsibilities as a **Psychiatric Director ** with YesCare with the Philadelphia Contract. + Provide... program in the region. Provide timely feedback in Utilization Management matters including outpatient and inpatient… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case ...cases for which criteria are not met to the Medical Director . + Demonstrates a working knowledge of ... quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible...System policy. + Serves as a liaison between the Medical Director , Physicians, and office staff in… more
- Evolent (Harrisburg, PA)
- …LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Evolent (Harrisburg, PA)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more