Utilization Review Jobs in Pennsylvania
1 - 15 of 48
Search Results - Utilization Review Jobs in Pennsylvania
Highmark Health-Allentown-appcast.io-
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...
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1 similar job: Philadelphia
Optum-Butler (PA)-
to resolve the issues.
/n
• Meets with medical director periodically and determines medical records for utilization review from branch offices.
/n
• Ensures all services are billed as provided to the proper payor source.
/n
• Provides input, guidance...
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Highmark Health-Pittsburgh-appcast.io-
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...
Read more
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...
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CVS Health-Pittsburgh-appcast.io-
CVS Health, through its Aetna division, seeks a Medical Director for remote-based work from home. This role oversees medical policy implementation, supports clinical programs, and directs utilization review with predetermination reviews.
Preference...
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Terra Consulting Group-Pittsburgh-
of work and the sharing of resources within the discipline, maximizing staff utilization. Reviews staff utilization regularly and promptly addresses staff not meeting utilization goals.
• Prepares for the future state of the discipline through succession...
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CVS Health-Philadelphia-appcast.io-
CVS Health, through its Aetna division, seeks a Medical Director for remote-based work from home. This role oversees medical policy implementation, supports clinical programs, and directs utilization review with predetermination reviews.
Preference...
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Terra Consulting Group-Allentown-
of work and the sharing of resources within the discipline, maximizing staff utilization. Reviews staff utilization regularly and promptly addresses staff not meeting utilization goals.
• Prepares for the future state of the discipline through succession...
Read more
CVS Health-Allentown-appcast.io-
CVS Health, through its Aetna division, seeks a Medical Director for remote-based work from home. This role oversees medical policy implementation, supports clinical programs, and directs utilization review with predetermination reviews.
Preference...
Read more
Terra Consulting Group-Philadelphia-
of work and the sharing of resources within the discipline, maximizing staff utilization. Reviews staff utilization regularly and promptly addresses staff not meeting utilization goals.
• Prepares for the future state of the discipline through succession...
Read more
Intermountain Health-Scranton (PA)-mindmatch.ai-
experience and all aspects of the Intermountain Operating Model. Participates in utilization review audits. Meetings : Participates in patient care conferences, interdisciplinary meetings, staff meetings, and necessary professional and work groups...
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Encompass Health Rehabilitation Hospital of Mechanicsburg-Mechanicsburg (PA)-
Ensure accuracy of discharge and payor-related information in the patient record
• Participate in utilization review process: data collection, trend review, and resolution actions.
• Participate in case management on-call schedule as needed...
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1 similar job: Grand Forks
Tender Care Hospice-Glenside-
Assist in orientation and education and educational presentations for hospice staff and medical community members.
§ Participate in QAPI and other assigned committees and Utilization Review activities.
§ Assist with employee health activities...
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Philadelphia-icims.com-
for decades to come, we have moved into a brand-new building.
We are seeking a clinical professional responsible for facilitating admissions, clinical intake assessments and utilization review processes to assure continuity for the most appropriate level...
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Nyx Health-Philadelphia-trinethire.com-
authorization, utilization review, insurance verification, and EMR systems.
[preferred]
Work Environment & Physical Requirements
• Remote position
• Daily computer use during an 8 hr. shift; ability to lift up to 15 lbs.
• Reliable Internet
• Full Time...
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