- Geisinger (Harrisburg, PA)
- … management of the Utilization Review policy and observation management performance including outcomes of medical necessity justification with health plan ... Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Trinity Health (Darby, PA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... the RN Care Coordination Manager, provides support to the utilization management , denials and appeals process for...are met + Collaborates with Physician Advisor to clarify medical necessity or clinical rationale + Assists in corresponding… more
- Intermountain Health (Harrisburg, PA)
- …In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director , and ... as an expert and local resource to hospital Case Management Department and Medical Staff on issues...Director . + Work with and support the Case Management Department to ensure appropriate admission and discharge status… more
- Guthrie (Sayre, PA)
- …CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer applications (such as ... Position Summary: The Utilization Management (UM) Reviewer, in collaboration...with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as… more
- UPMC (Moosic, PA)
- …and evaluating protocols. + Review the medical aspects of cost and utilization reports generated by Medical Management Information System + Acts ... We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team...care managers in the utilization of appropriate medical necessity criteria and ensures appropriate care management… more
- Commonwealth of Pennsylvania (PA)
- Assistant Medical Director ( Management Physician) Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4550940) Apply Assistant Medical ... seeking a seasoned physician to serve as our Assistant Medical Director . This position gives you the...nurses through the use of the Quality Improvement program, utilization management , and the grievance system. Bring… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... and help us put health first** The Behavioral Health Medical Director may develop procedures, processes, productivity...with prior experience participating in teams focusing on quality management , utilization management , case … more
- CenterWell (Harrisburg, PA)
- …a part of our caring community and help us put health first** **National** ** Director of Transitional Care and High-Risk Patient Management ** The Director ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- UPMC (Pittsburgh, PA)
- The Medical Director is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. ... Health Plan's established policies. + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical ... The Associate director will report to LGHP Medical Director and have a reporting relationship...provided by the Hospitalists, quality improvement, education of staff, medical and utilization review and feedback, and… more
- UPMC (Pittsburgh, PA)
- **UPMC Mercy Hospital is searching for our next leader! This Unit Director role will oversee our 6A Withdrawal Management Unit as well as our Evaluation and ... workplace for staff, and overseeing clinical, and administrative/business functions. The Unit Director is responsible for collaborating with medical staff to… more
- CVS Health (Harrisburg, PA)
- …timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance ... and have a PA/WV/DE License without encumbrances. In the Medical Director role you will provide oversight...clinical / medical programs and expand Aetna's medical management programs to address member needs… more
- Humana (Harrisburg, PA)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with ... of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice… 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...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- Penn Medicine (Philadelphia, PA)
- …business planning and financial management , ensuring the accomplishment of management goals and objectives. The Director Division Administration (DDA) has ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- University of Pennsylvania (Philadelphia, PA)
- …employees, including salaried professionals, hourly workers, and unionized staff. The Director oversees a multifaceted portfolio, including revenue management , ... of health and wellness programs and resources, and much more. Posted Job Title Director , Parking Services Job Profile Title Associate Director D, Business and… more
- University of Pennsylvania (Philadelphia, PA)
- …and housekeeping needs. Develops plans related to facility planning, space utilization and management , safety and accessibility requirements. Coordinates ... home competitions. Job Description Job Responsibilities + Assists the Associate Director , Facility Operations with supervision and management of recreation… more
- Devereux Advanced Behavioral Health (Malvern, PA)
- …their families. Management of the fiscal budget to include bed utilization , FTE planning/ utilization and monitors other operational expenses and sources of ... Are you skilled in managing behavioral health funding, reimbursements and bed utilization ? Do you excel at fostering a work environment that promotes accountability,… more