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UPMC
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Pittsburgh, Pennsylvania
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product standardization/utilization initiatives. This individual coordinates new product introduction ... use of products and services at all UPMC business units and facilities through collaborative efforts
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CVS Health
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Harrisburg, Pennsylvania
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Position Summary
This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state.
As a Utilization Management Nurse Consultant, you will utilize
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Genex Services, LLC.
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Wayne, Pennsylvania
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Desired Skills and Experience:
*
Prior review experience in healthcare, insurance, utilization ... Genex Service LLC Utilization Reviewer 2 US--Remote Job ID: 24-16838 Type: Regular
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CVS Health
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Harrisburg, Pennsylvania
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Position Summary
This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.
As a Utilization Management Nurse Consultant, you will
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Penn Medicine
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Philadelphia, Pennsylvania
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to physician and clinic schedule utilization and management to enhance access to all patients ... ). Education Specialization:Business Administration, Public Health, Healthcare Administration, Management, or
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Humana
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Harrisburg, Pennsylvania
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comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management ... independent determination of the appropriate courses of action.The Utilization Management Clinical Pharmacist
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Universal Health Services
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SHIPPENSBURG, Pennsylvania
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Responsibilities
Clininical Supervisor - Social Work/Utilization Management ... utilization management departments on our acute psychiatric units. This is an operational leader position
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Guthrie
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Sayre, Pennsylvania
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services, including staffing, resource allocation, budget management, and regulatory compliance ... and sleep medicine services, optimizing resource utilization and revenue generation.
Identify
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Universal Health Services
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SHIPPENSBURG, Pennsylvania
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Responsibilities
Clininical Supervisor - Social Work/Utilization Management ... utilization management departments on our acute psychiatric units. This is an operational leader position
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Highmark Health
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Pittsburgh, Pennsylvania
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outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization. Serves as key team members in the management of readmissions, length of stay, ED utilization, and patient
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Humana
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Harrisburg, Pennsylvania
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healthcare providers, clinical group practice management.
Utilization management experience in a medical ... medical interpretation and determinations whether services provided by other healthcare professionals are
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Geisinger
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Bloomsburg, Pennsylvania
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services with the goal of optimizing the patient or member's health status. Manages utilization and ... services.
Continuously evaluates laboratory results, diagnostic tests, utilization patterns and
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UPMC
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Pittsburgh, Pennsylvania
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the interdisciplinary team summarizing clinical and social history, healthcare resource utilization ... year of experience in clinical, utilization management, home care, discharge planning, and/or case
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Universal Health Services
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DOYLESTOWN, Pennsylvania
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Management Coordinator is responsible for all utilization management activities for assigned cases from ... .
Maintains data on utilization management activities and generates required reports, logs, and files as
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UPMC
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Franklin, Pennsylvania
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summarizing clinical and social history, healthcare resource utilization, case management interventions ... health or lifestyle management.
Contact members with gaps in preventive health care services and
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Highmark Health
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Monroeville, Pennsylvania
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, and supports effective resource utilization. Serves as key team members in the management of ... standards of practice for case management by collaborating with providers, clinical teams, health plans, and
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Guthrie
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Sayre, Pennsylvania
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Position Summary:
The Utilization Management (UM) Reviewer, in collaboration with ... Utilization Management (UM) processes and requirements for prior authorization/certification for reimbursement
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Highmark Health
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Natrona Heights, Pennsylvania
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Highmark Health, is transforming the future of healthcare by providing highly effective services to ... utilization management. (50%)
Communicates and collaborates with physicians and multidisciplinary teams
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CVS Health
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Harrisburg, Pennsylvania
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programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and ... the coordination and administration of the utilization/benefit management function.
Typical
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UPMC
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Pittsburgh, Pennsylvania
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summarizing clinical and social history, healthcare resource utilization, case management interventions ... health or lifestyle management.
Contact members with gaps in preventive health care services and
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Humana
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Harrisburg, Pennsylvania
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, utilization management, case management, discharge planning and/or home health or post acute services such as ... interpretation and determinations whether services provided by other healthcare professionals are in agreement
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Humana
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Harrisburg, Pennsylvania
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medical interpretation and determinations whether services provided by other healthcare professionals are ... participating in teams focusing on quality management, utilization management, case management, discharge
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Highmark Health
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Harrisburg, Pennsylvania
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patient, and then creates the case (data entry) in Highmark's utilization management system for clinical ... utilization management system.
Use knowledge of process and judgement to evaluate identified cases that
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Highmark Health
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Harrisburg, Pennsylvania
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patient, and then creates the case (data entry) in Highmark's utilization management system for clinical ... utilization management system.
Use knowledge of process and judgement to evaluate identified cases that
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Humana
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Harrisburg, Pennsylvania
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position with responsibility for utilization management and clinical decision-making as outlined in the ... **
Tasks include, but are not limited to:
70% :
Performing utilization management
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CVS Health
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Harrisburg, Pennsylvania
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wraparound services to promote effective utilization of available resources and optimal, cost-effective ... knowledgably participate with their provider in healthcare decision-making.
-Analyzes all utilization
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UnitedHealth Group
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Pittsburgh, Pennsylvania
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Enterprise Clinical Services Medical Directors on performing utilization management
Participation in ... care services are delivered.
As an Inpatient Care Management Nurse, you will be responsible for
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LHC Group Inc.
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Scranton, Pennsylvania
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Manager with managing various software system reports for the effective care coordination and utilization management that promotes positive patient outcomes (for example but not limited to, therapy utilization
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Humana
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Harrisburg, Pennsylvania
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and determinations whether services provided by other healthcare professionals are in agreement with ... prior experience participating in teams focusing on quality management, utilization management, case
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WorkLink Staffing
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Irwin, Pennsylvania
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intention to be hired on permanently. Benefits at that time include UPMC healthcare, United Concordia ... mitigation
- Perform to all measured productivity, utilization, scrap, and rework standards/goals
- Any
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