Utilization Manager Jobs in Pennsylvania
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Search Results - Utilization Manager Jobs in Pennsylvania
Highmark Health-Allentown
Highmark Inc. is seeking a physician to be part of a team that performs utilization management in line with the highest clinical standards.
The role reviews escalated cases electronically using Medical Policy criteria to assess medical necessity...
appcast.io -
1 similar job: Philadelphia
Community Behavioral Health.-Philadelphia
Job Description
Job Description
The IBHS Clinical Care Manager – Neurodevelopmental Services (CCM-ND) is responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, provider...
Highmark Health-Pittsburgh
Highmark Inc. is seeking a physician to be part of a team that performs utilization management in line with the highest clinical standards.
The role reviews escalated cases electronically using Medical Policy criteria to assess medical necessity...
appcast.io -
UPMC - Pittsburgh Medical Center-Franklin (PA)
to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions.
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• Update the plan of care following review and communicate recommendations to the member...
ChristianaCare-Avondale (PA)
patient care and drive patient progression and establish a discharge plan.
• Social Worker – resolve psycho-social barriers and supports discharge needs.
• Utilization Management – review patient status for appropriateness and anticipated payer coverage...
54 similar jobs: Newport, Elkton, Glen Mills, Hockessin, Rockland...
UPMC - Pittsburgh Medical Center-Harrisburg
and utilization management (UM) professionals to meet physicians’ orders and patients’ needs.
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• RN will coordinate case management activities across a multi-disciplinary health care team to ensure appropriate, quality patient care.
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• Initiate, deliver...
1 similar job: Mechanicsburg
SOCOTEC-Philadelphia
forecasting, utilization management, margin optimization, and cash flow
• Establish and optimize operational processes, quality management systems, and safety protocols specific to the Service Line
• Implement KPIs and performance metrics to drive...
3 similar jobs: San Diego, Washington, Baltimore
Techstra Solutions-Pittsburgh
allocation, and utilization management.
• Mentor and develop delivery managers, project managers, and consultants.
• Partner with recruiting and practice leaders to ensure appropriate staffing.
• Foster a culture of accountability, collaboration...
UPMC - Pittsburgh Medical Center-Altoona (PA)
Your role as the nurse will establish patients’ plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians’ orders and patients’ needs.
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• RN will coordinate case management activities...
FHAS, LLC-Wilkes Barre
Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare...
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Carlisle (PA)
initiatives. You’ll be the key Social Services voice in Morning Meetings and Utilization Management.
• Discharge Mastery: Coordinate seamless transitions back to the community by building strong linkages with behavioral health, hospice, and other community...
genesiscareers.jobs -
Optum-State College
and implements processes and best practices to ensure positive patient outcomes
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• Participates in on-call and weekend rotation as needed to meet patient needs
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• Adheres to and participates in the agency's utilization management model
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• Ability...
Geisinger-Wilkes Barre
of services.
• Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population.
• Works to appropriately apply benefits and utilization management serving...
Access Services-Fort Washington (PA)
compliance, utilization management, billing oversight, outcome measurement, and quality assurance. Working closely with Service Line leadership, they will drive continuous improvement, monitor key performance indicators, strengthen community partnerships...
workable.com -
Access Services-Bethlehem (PA)
compliance, utilization management, billing oversight, outcome measurement, and quality assurance. Working closely with Service Line leadership, they will drive continuous improvement, monitor key performance indicators, strengthen community partnerships...
workable.com -
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