- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview Under the direction of a supervisor , the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ... making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... timely engagement of case management of all transplant members. Conduct utilization management reviews for all transplant services by assessing medical… more
- AmeriHealth Caritas (Newtown Square, PA)
- …with providers and appropriate others to facilitate and coordinate the Utilization Management process(es) activities. Utilize technology and resources (systems, ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Ryder System (Harrisburg, PA)
- Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) . Job Description : SUMMARY This position ... vendors retained for investigations, cost containment, expert witnesses, and litigation management to ensure claims are being handled properly according to the… more
- Breakthru Beverage Group (North Wales, PA)
- …or investigation as needed. Reviews distribution productivity reporting to appropriate supervisor for review and determination. Suggests efficiency ideas, cost ... analytics to Drivers, Routing, Safety, and compliance. This role will review routes, route plans, stop types, service times, classifications, driver performance,… more
- Geisinger (Dickson City, PA)
- …all Revenue Management teams and departments including Practice Consultants, Utilization Management and Care Management , Providers, Geisinger ... in and out surgeries and outpatient clinical departments. Follows Revenue Management policies and procedures regarding financial matters and payment arrangements.… more
- University of Pennsylvania (Philadelphia, PA)
- …university closures, delayed openings, or early dismissals, unless otherwise directed by your supervisor or a member of the senior management team. Additionally, ... and performance evaluations of assigned staff. Collect data on program utilization , outcomes, and satisfaction to evaluate effectiveness and make improvements.… more
- CVS Health (Fairless Hills, PA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... readiness increase, you will take on greater accountability for supporting the management , oversight, and operations within the pharmacy, including but not limited… more
- AmeriHealth Caritas (Philadelphia, PA)
- … Review Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical ... . **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily… more
- TAIT Towers (Lititz, PA)
- …Bloomberg, Google, Beyonce, and The Olympics Position Purpose The purpose of the Operations Supervisor is to manage and develop the employees that report to them in ... as well as complying with all TAIT policies. The Supervisor is responsible for monthly planning in the areas...policies and expectations prescribed by the company * Overall management and direction of all direct employees within their… more
