- Highmark Health (Pittsburgh, PA)
- …in planning/marketing strategy to ensure referral sources. + Participates in peer utilization and/or review and assists in coordination of related quality ... **Company :** Allegheny Health Network **Job Description :** GENERAL OVERVIEW: Provides...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- WellSpan Health (Hanover, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education relative to … more
- Highmark Health (Harrisburg, PA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- St. Luke's University Health Network (Sellersville, PA)
- … health /crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... assists other hospital services or external customers, in accessing the network Behavioral Health Services. JOB DUTIES AND RESPONSIBILITIES: + Conducts intake… more
- Highmark Health (Jefferson Hills, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management… more
- Highmark Health (Pittsburgh, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered...as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer… more
- Highmark Health (Harrisburg, PA)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors… more
- Highmark Health (Harrisburg, PA)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- St. Luke's University Health Network (Allentown, PA)
- …pay for health care. The Music Therapist serves as a licensed behavioral health professional within the interdisciplinary treatment team of the Acute Partial ... as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless… more
- UPMC (Murrysville, PA)
- …that include the medical, behavioral , pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic ... and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system… more
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