- UPMC (Pittsburgh, PA)
- …Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- 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
- Ankura (PA)
- …objectives, streamline processes, and foster sustainable growth. Role Overview: This Senior Managing Director will join the leadership team of Strategy & ... capabilities, and sets the overall strategy for the practice. Additionally, the Senior Managing Director will lead and oversee multiple client engagements within… more
- Grant Thornton (Pittsburgh, PA)
- As the Managing Director , Corporate Tax Solutions you'll deliver personalized relationship driven services to create demand in the Pittsburgh market while ... review and client management + Meet or exceed targeted billing hours ( utilization ), sales targets for new and follow-on work as well as managed revenue targets… more
- Ankura (PA)
- …any cyber incident. Role Overview:The Global Sales Cybersecurity and Data Privacy Senior Managing Director is an executive level position that leads global sales ... development and execution, key performance indicators/metrics, and strategic account management . + Initiates and converts business opportunities and collaborates… 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
- Penn Medicine (Philadelphia, PA)
- …This role will be the PAH collaborative interface with physicians, materials management , supply chain, DTS and others for new technology. It is anticipated ... off campus. + Provide Physician leadership and partner with the CNO and Clinical Director (s) and operational leaders to lead the PAH OR committees, represent PAH on… 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