- Windstream (Harrisburg, PA)
- …in a world of infinite possibilities! About the Role: The Account Development Director will focus on business development, by selling Windstream's full suite of ... wallet share, increase customer satisfaction, reduce churn, and increase customer utilization of our strategic next-gen services. The Account Development Director… more
- WellSpan Health (York, PA)
- …Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management Committee (URC) meetings. Prepares ... and oversees the operations of the utilization management department. Works with hospital, regional, medical ... Management Committee. + Works closely with Medical Director to identify trends in payor… more
- CVS Health (Harrisburg, PA)
- …Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds… 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 actively uses their 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 ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… 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 actively uses their medical...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Pop Health...cases for which criteria are not met to the Medical Director . + Demonstrates a working knowledge of ... quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible...System policy. + Serves as a liaison between the Medical Director , Physicians, and office staff in… 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 ... but strong needs for clinical knowledge to leverage payors. Position Summary: The Utilization Management (UM) Reviewer, in collaboration with other internal and… more
- Evolent Health (Harrisburg, PA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... processing medical treatment requests in accordance with departmental policies, regulatory...client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager,… more
- Evolent Health (Harrisburg, PA)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + ... for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you...of Orthopedic Surgery or Orthopedic Spine Surgery + Administrative Medical Experience- Utilization Management , Leadership… 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/4612319) Apply Assistant Medical ... looking for an established physician to serve as Assistant Medical Director . If you have a passion...nurses through the use of the quality improvement program, utilization management , and the grievance system. Interested… more
- Humana (Harrisburg, PA)
- …relationships, value-based care, quality metrics, population health, and disease or care management . The Behavioral Health Medical Director may develop ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...healthcare providers, clinical group practice management + Utilization management experience in a medical… more
- CVS Health (Harrisburg, PA)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to… 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
- CVS Health (Harrisburg, PA)
- …physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions * Participate in ... based (work from home) role.** In this role has Medical Director (Behavioral Health) you will: *... programs * Provide psychiatric leadership to an interdisciplinary utilization management team, including medical /clinical… more
- Spectrum Health Services (Philadelphia, PA)
- …for identifying said population via provider/external health facility referral, utilization management referral, disease registry reporting mechanisms and ... + Nurse Practitioner + Three years minimum managerial experience + FQHC experience preferred Keyword: Senior Medical Director From: Spectrum Health Services, Inc 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
- Organon & Co. (Plymouth Meeting, PA)
- **Job Description** **The Position** The National Account Director (NAD), Payer Segment, will report to the Executive Director of National Payer Segment. The NAD ... leads all account management efforts with assigned Pharmacy Benefits Manager (PBM) and...as other extended account team members to maximize appropriate utilization of the Company's products. Integrates Senior Leadership into… more
