- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- Humana (Harrisburg, PA)
- …reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Harrisburg, PA)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Harrisburg, PA)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- CenterWell (Harrisburg, PA)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical … more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Radiology you will be a key member of the utilization management team. We can offer you...review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization … more
- Evolent (Harrisburg, PA)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Centene Corporation (Harrisburg, PA)
- …certified in Family Medicine or Internal Medicine or Emergency Medicine + Utilization Management experience and knowledge of quality accreditation standards ... highly preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management...business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality… more
- Evolent (Harrisburg, PA)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you...review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization … more
- Humana (Harrisburg, PA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Harrisburg, PA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Humana (Harrisburg, PA)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review… more
- Humana (Harrisburg, PA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , or similar activities **Preferred ... community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare...Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience… more
- Humana (Harrisburg, PA)
- …and interpretation skills with prior experience leading teams focusing on quality management , utilization management , discharge planning and/or home health ... and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims....your skills to make an impact** **Required Qualifications** + MD or DO degree + A current and unrestricted… more
- Wolters Kluwer (Harrisburg, PA)
- …of Wolters Kluwer's CP & ESG Division) is a leading Corporate Performance Management software vendor. In addition to providing a unified Performance Management ... ESG, Tax, Insurance & Banking. The **North American** team is seeking a ** Director of Solution Consulting, North America** to lead a high-performing team of solution… more
- Evolent (Harrisburg, PA)
- …medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in advancing value-based… more
- Travelers Insurance Company (Harrisburg, PA)
- …is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties **What ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more