- ChenMed (Philadelphia, PA)
- …work experience required + A minimum of one (1) year of utilization review and/or case management , home health, hospital discharge planning experience ... patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with...individual patient care plans + Knowledge of nursing and case management theory and practice + Knowledge… more
- Highmark Health (Pittsburgh, PA)
- …and civil law related to insurance fraud and advances in the post-payment utilization review process + Comprehensive knowledge of legal and investigative ... the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the...and authority. + Provides daily direction and oversight to management and team leads regarding case investigation… more
- Evolent (Harrisburg, PA)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Therapy you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Exelon (Plymouth Meeting, PA)
- …Responsibilities to include, but not limited to, contractor safety, construction site management , scope change management , job progression, invoice approval, and ... Responsibilities to include, but not limited to, contractor safety, construction site management , scope change management , job progression, invoice approval, and… more
- Highmark Health (Pittsburgh, PA)
- …leadership team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality ... Physician Advisor works in concert with the admitting physician, Case Management , and other hospital personnel, to...appeal letters and participates in data collection activities for utilization management . + Receives daily report from… more
- UPMC (Pittsburgh, PA)
- …for Comprehensive Medication Review as appropriate. + Refer members to appropriate case management , health management , or lifestyle programs based on ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of… more
- St. Luke's University Health Network (Allentown, PA)
- …an acute care hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial ... Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office. + Monitors retro denials to ensure… more
- UPMC (Pittsburgh, PA)
- …clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the ... experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management preferred.… more
- Penn Medicine (Philadelphia, PA)
- …advancing their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with ... DME, placements, hospice, community resources, and transportation. Quality data collection and risk management referrals. Case management allows you to work… more
- CenterWell (Lancaster, PA)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...of care analysis to determine efficiency, the efficacy of case management system as well as any… more