- WellSpan Health (York, PA)
- Director - Utilization and Denials Management Location: WellSpan Health, York, PA Schedule: Full Time General Summary Supervises and oversees the ... the System. Duties and Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for… more
- Guthrie (Sayre, PA)
- …but strong needs for clinical knowledge to leverage payors. Position Summary: The Utilization Management (UM) Reviewer, in collaboration with other internal and ... payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification… more
- UPMC (Moosic, PA)
- …consultation with practitioners in the field. This includes significant responsibility for quality management and utilization management and for assuring the ... the providers in its network. + Reviews proposed service denials and supervises care managers in the utilization...protocols. + Review the medical aspects of cost and utilization reports generated by Medical Management Information… more
- CVS Health (Harrisburg, PA)
- …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... prior authorization reviews with peer to peer coverage of denials . * Appeals - The medical director ...state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another… more