- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ \#LI-TB1 IND567 **Union:** Non Bargained **Position** Manager Utilization Management - Utilization ... **SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH,… more
- Highmark Health (Harrisburg, PA)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... Management Knowledge: A strong understanding of utilization management principles, processes, and industry best practices. + Clinical Knowledge: Familiarity… more
- Healthfirst (PA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Genesis Healthcare (York, PA)
- …while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical, administrative, and ... responding to the needs of its payor customers. The Manager will also perform the functions of the Case...of clinical nursing experience is required. Prior experience in utilization review, case management or discharge planning… more
- Penn Medicine (Philadelphia, PA)
- …+ Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + ... not limited to admissions, patient financial services, clinical resource management and provider medical staff and designees.Assist in preparation...And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and… more
- Motion Recruitment Partners (Harrisburg, PA)
- Sr. Mission Manager **Remote Only** Contract to Hire $70/hr - $100/hr **TG Federal is actively seeking a Sr. Mission Manager to join our remote team of ... Cybersecurity professionals.** **Summary:** The Sr. Mission Manager is a hybrid leadership role that combines the...operations team. + Track, manage, and report on labor utilization , forecasting, and burn rates to ensure alignment with… more
- Highmark Health (Erie, PA)
- …effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family ... or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case … more
- St. Luke's University Health Network (Allentown, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... Care Manager coordinates the overall progression of care, resource utilization , and discharge planning for designated patient populations across the continuum of… more
- CDR Maguire (Allentown, PA)
- …- As overseen by the PA Director of Construction Services and Construction Services Manager - PA East, provide Construction Management Support for PennDOT and PA ... Preferred- Professional Engineer in Pennsylvania for Civil Engineering (PE); Project Management Professional (PMP); Certified Construction Manager (CCM). +… more
- Penn Medicine (Lancaster, PA)
- … management platform/analytics. + Analyzes data to identify under/over utilization ; improve resource consumption; promotes potential reduction in cost and ... per week). Monday-Friday (8am-4:30pm). No weekends or holidays. The Ambulatory Case Manager will provide support to physicians, clinical staff and patients who fall… more
- St. Luke's University Health Network (Souderton, PA)
- …of a patient's ability to pay for health care. The Care Manager is responsible for conducting facility and community based comprehensive biological, psychological, ... outcomes are consistent with the individuals' needs and desired outcomes. + On-going management of the ISP in cooperation with individual, his/her family, members of… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- Highmark Health (Harrisburg, PA)
- …managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan. + ... pharmacy strategies and other pharmacy strategy teams to execute on the formulary/ utilization (UM) and other strategic pharmacy products. This job will be… more
- Select Medical (Mckeesport, PA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager (PRN)** _Requires a current licensure in a...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Select Medical (York, PA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager ** _Requires a current licensure in a clinical...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Centene Corporation (Harrisburg, PA)
- …or medical group experience, provider relations, quality improvement, claims, contracting utilization management , or clinical operations. Project management ... align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in… more
- Highmark Health (Monroeville, PA)
- …and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization changes, ... or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case … more
- Grifols Shared Services North America, Inc (Pittsburgh, PA)
- …specified "Account List" of Health Systems designed to increase the adoption and utilization of the Grifols Bleeding Management product portfolio. The KAM's ... role in the successful launch of a new Bleeding Management product within the Grifols Biopharma portfolio. The KAM...provide any necessary support to the responsible National Account Manager (NAM) in the execution of the contracting process… more
- St. Luke's University Health Network (Allentown, PA)
- …patient's ability to pay for health care. The IT Vendor and Contracts Manager leads IT's Vendor/Contact Management Office (VCMO). Responsibilities include but ... and attainment, reporting and governance. At an operational level, the Manager directs contract consultations and negotiations, including contract reviews, analysis,… more
- UPMC (Washington, PA)
- The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the ... care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and… more