- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… 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 ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … 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 ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … 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 ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Select Medical (Camp Hill, PA)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **_Clinical license...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more
- Centene Corporation (Harrisburg, PA)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- Evolent (Harrisburg, PA)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Evolent (Harrisburg, PA)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a specialty match...cases. you will be a key member of the utilization management team. We can offer you… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- United Therapeutics (Harrisburg, PA)
- …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more
- CBRE (Harrisburg, PA)
- Executive Director , Operations Management - OnDemand & Variable Tech Job ID 220744 Posted 11-Jul-2025 Service line GWS Segment Role type Full-time Areas of ... Interest Facilities Management Location(s) Remote - US - Remote - US...technicians and 3P service providers, ensuring optimal route planning, utilization , and service quality across all geographic regions. +… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Harrisburg, PA)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Harrisburg, PA)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more
- CVS Health (Harrisburg, PA)
- …ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality ... ability to obtain a NJ License. In the Medical Director role you will provide oversight for medical policy...of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum… more
- Evolent (Harrisburg, PA)
- …billing and various sites of care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical ... a company behind it. **What You'll Be Doing:** **Associate Director , Performance Analytics - Oncology & Member Product Focus**...role plays a critical part in both **Medical Cost Management ** and **Product Management ** , leveraging advanced… more
- CVS Health (Harrisburg, PA)
- …Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license without ... coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and clinical liaison to… more
- Highmark Health (Harrisburg, PA)
- …clinical operations and care management functions + Understanding of Care Management & Utilization Management business processes **LICENSES or ... :** enGen **Job Description :** **JOB SUMMARY** This job will have director level accountability for the Clinical Services product engineering team and associated… more
- Humana (Harrisburg, PA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance ... and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health...review health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity… more