Utilization Review Jobs in Philadelphia
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Search Results - Utilization Review Jobs in Philadelphia
Highmark Health-Philadelphia-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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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-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-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...
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ANCHomeHealthService-Philadelphia-
to ensure all clinical documentation is current and properly maintained.
• Tracking compliance gaps, deficiencies, utilization review statistics, and other quality metrics for leadership review.
• Participating in case conferences and supporting accurate...
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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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Intercommunity Action I-Philadelphia-
utilization review for all staff on a quarterly basis at a minimum.
14. Monitor staffing needs and work proactively with Human Resources to address any hiring, credentialing, or professional development needs. This includes an emphasis on expanding...
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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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SSWAA-Philadelphia-appcast.io-
and efforts to the faithful performance and rendering of professional services on an exclusive basis in the practice of medicine, teaching and research activities, including participation in outreach activities, medical audit activities, utilization review...
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ICBD-Philadelphia-workable.com-
you will have the opportunity to grow into multiple specialized career paths across the company. We are committed to supporting long-term professional development in areas such as Clinical Leadership, Operations, Quality Assurance (QA), Utilization...
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Philadelphia-colliersengineering.com-
a production team.
• Evaluate and monitor budgets, billing, and collections.
• Consistently monitors the backlog of work and the sharing of resources within the discipline, maximizing staff utilization. Reviews staff utilization regularly and promptly addresses...
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Dane Street, LLC-Philadelphia-workable.com-
medical record reviews, utilization review, and evidence-based advisory assessments while maintaining flexibility and working remotely....
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9025 CVS Shared Services Resources LLC-Philadelphia-appcast.io-
Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews.
This includes Prior...
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Highmark Health-Philadelphia-appcast.io-
Company : Highmark Inc.
Job Summary
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases...
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Encompass Health Rehabilitation Hospital of York-Philadelphia-
a graduate degree is preferred.
• Three years of hospital-based Case Management experience, including Utilization Review and Discharge Planning experience.
• May be required to work weekdays and/or weekends, evenings and/or night shifts.
• May be required...
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