- Spectrum Health Services (Philadelphia, PA)
- …for identifying said population via provider/external health facility referral, utilization management referral, disease registry reporting mechanisms and ... in nursing care and practice in accordance with all regulatory requirements and accreditation standards. The Senior Clinical Director is responsible for building… more
- CVS Health (Trenton, NJ)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors… more
- Evolent Health (Trenton, NJ)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Reviewer you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent Health (Trenton, NJ)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Penn Medicine (Philadelphia, PA)
- …and supportive services; integration with multiple specialties; efficient access management processes in coordination with referral sources; sustained patient ... initiatives for the disease-based programs. Responsibilities: Leadership on Operations, Clinical Management and Program Development + Serves as a core resource for… more