- CVS Health (Harrisburg, PA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Harrisburg, PA)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- Highmark Health (Camp Hill, PA)
- …as the clinical subject matter expert for clinical , quality, care, utilization , high cost claim and population health management as the part of the ... markets. The incumbent is primarily accountable for the delivery of clinical analysis and strategies for Highmark customers, including healthcare consultants and… more
- Penn Medicine (Philadelphia, PA)
- …Research with a focus on supply chain, patient throughput, resource allocation and utilization , queuing theory and capacity management to help optimize business ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Highmark Health (Pittsburgh, PA)
- …set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected… more
- Henderson Brothers Inc. (Pittsburgh, PA)
- …+ Expertise in PBM operations, plan design, industry compliance, and clinical cost-containment strategies + Strong client relationship management and ... strategy, and deep industry knowledge. We're looking for a Pharmacy Benefits Consultant to join our growing Pharmacy Consulting Practice and help clients navigate… more
- IQVIA (Wayne, PA)
- …position, you must reside in the same country where the job is located._ ** Consultant - Commercial Solutions & Insights Hub (CSIH), Analytics Pillar** IQVIA CSIH is ... trends in complex data sets. + Provide Business Consulting and Project Management : The candidate will apply consulting methodologies to deliver engagements, create… more
- Cardinal Health (Harrisburg, PA)
- …a highly regulated industry + Previous sales experience selling to physicians, clinical end-users, materials management , and C-suite desired + Strong preference ... Job Description **Senior Consultant , Product Sales Specialist - NPHS** **The territory covers Pennsylvania (Philadelphia, Pittsburgh and Allentown), Maryland… more
- Highmark Health (Harrisburg, PA)
- …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
- UPMC (Pittsburgh, PA)
- …product portfolio, drive cost reduction initiatives throughout UPMC and act as a consultant to and supporting resource for the clinical and non- clinical ... request system (MedApproved) across UPMC entities. + Manages communications and clinical literature research to support product utilization , product conversions… more
- Elevance Health (PA)
- …clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...discuss review determinations. + Serves as a resource and consultant for other areas of the company. + May… more
- UPMC (Harrisburg, PA)
- …years of clinical experience + Minimum of 2 years of relevant clinical specialty experience + Leadership and project management experience preferred + ... infants, offering advanced respiratory support, surgical recovery, and complex medical management . The unit is staffed by a dedicated team of neonatologists,… more
- UPMC (Pittsburgh, PA)
- …of clinical experience + Minimum of 2 years of relevant clinical specialty experience + Leadership and project management experience preferredLicensure, ... with the health care team, the Programmatic Nurse Specialist applies expert clinical knowledge and skills to achieve quality patient outcomes. Responsibilities: +… more
- Highmark Health (Blue Bell, PA)
- …for innovation and ensure compliance with evolving regulations. By leveraging clinical expertise and strategic thinking, the consultant drives data-informed ... in partnership with our external entity partners + Provide Clinical Expertise and stakeholder engagement for all VBR contracts...Quality Improvement + 3 - 5 years in Care Management + 3 - 5 years in Utilization… more
- UPMC (Washington, PA)
- …our healthcare system. Key Responsibilities + Lead multidisciplinary teams to improve clinical outcomes and reduce resource utilization while promoting quality ... the facility contact for PHC4, PHCQA, and UPMC Risk Management . + Ensure readiness for DOH Licensure and Joint...and policy/procedure development. + Act as a senior internal consultant for clinical measurement, analysis, and reporting.… more
- UPMC (Pittsburgh, PA)
- …standard business hours Monday through Friday. In this role, you will review clinical documentation within the medical record to ensure that all patient resource ... utilization , principal diagnosis, secondary diagnoses, and PCS procedures have...guidelines. + Formulate physician queries that present indications, utilizing clinical judgment, of a diagnosis that is not clearly… more
- Veterans Affairs, Veterans Health Administration (Wilkes Barre, PA)
- …and respond to critical lab/diagnostic test result notifications in a timely manner Clinical Management including direct and indirect patient care: ensure all ... Centers, Home Based Primary Care, Hospital In Home, Geriatric Evaluation Management (GEM) Clinic and Palliative/Hospice Care Service. The 2-page Resume requirement… more
- Penn Medicine (Philadelphia, PA)
- …leading and managing their departments with a focus on driving change and utilization of change management tools. + Completes on-boarding interviews within the ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more