- Evolent (Harrisburg, PA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a...you ready to make a meaningful impact on patient care in a non- clinical setting? Join our… more
- Veterans Affairs, Veterans Health Administration (Aspinwall, PA)
- …design, develop, or adapt unique music therapy methods as needed. Completes clinical documentation of patient care including assessments, progress notes, ... H. J. Heinz Division under the Geriatrics and Extended care Line at the Veterans Affairs Pittsburgh Healthcare System...Therapist (Music) include but are not limited to : Clinical : Administers music therapy assessments and develops relevant music… more
- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience +… more
- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management… more
- St. Luke's University Health Network (Bethlehem, PA)
- …Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care /Outcomes, Customer/Service Improvement. Operational System/Process, and ... which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses...systems. Reports to DEA as required. + Assists with review of pharmacy-related patient and family educational materials. +… more
- Genesis Healthcare (Mechanicsburg, PA)
- … Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the ... department, including oversight related to case management, quality improvement, care planning, clinical utilization, and patient identification is… more
- CVS Health (Pittsburgh, PA)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical ...* 2 or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
- Geisinger (Wilkes-Barre, PA)
- …priorities. Some of those responsibilities include, but are not limited to, daily review of the clinical management guidelines for each patient, direct patient ... and system outcomes + Assumes the role of clinical expert. + Coordinates patient care placing...information into monthly quality improvement report and forwards initial review to leadership for secondary review and… more
- Highmark Health (Erie, PA)
- …diverse patient population of all ages, ranging from routine care to urgent care needs. + **Enjoy a variety of clinical services.** You'll be challenged and ... are looking for an APP who:** + **Is passionate about providing exceptional patient care .** + **Possesses strong clinical skills and a keen eye for detail.**… more
- Intermountain Health (Harrisburg, PA)
- …documents patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care . Plans ... the complex health system and that help reduce/remove barriers to care . Responsible for clinical support and coordination related to value based care … more