- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …(HCC's) Completes assignments with an emphasis on completeness, accuracy, and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. ... diagnoses. The Certified Risk Adjustment Coding/Audit Specialist analyzes and translates concurrent , prospective and retrospective medical and clinical diagnoses… more
- Centene Corporation (Harrisburg, PA)
- …in the week. Eligible for 4-10HR shifts, or 5-8HR shifts. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient...preferred. Experience working with providers and healthcare teams to review care services related to mental health… more
- UPMC (Pittsburgh, PA)
- …delays in discharge. + Documents all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria to ... fulfilled this mission since its founding in 1890.** The Care Manager (CM) coordinates the clinical and...information for JCAHO requirements. + Takes leadership role in concurrent denial process. Works with Care Management… more
- UPMC (Pittsburgh, PA)
- …Actively participates in the daily utilization management and quality improvement review processes, including concurrent , prospective and retrospective reviews, ... for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. They oversee adherence to quality and… more
- Guthrie (Sayre, PA)
- …and educational activities. a) Incorporates available current evidence-based data for clinical care management. b) Demonstrates knowledge of federal, state ... in an acute care setting with strong care management, utilization review , and payer knowledge....with the patient and family/caregivers, physician and other health care providers to achieve designated clinical , operational… 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...Trauma Registry. + Maintains trauma roster and updates on concurrent basis. + Summarizes concurrent daily chart… more
- Cardinal Health (Harrisburg, PA)
- …to rethink the reach and impact of their products. **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for ... (TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy… more
- Healthfirst (PA)
- …coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge planning, and case management as assigned. The ... Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize… more
- UPMC (Pittsburgh, PA)
- …The Clinical Documentation Specialist (CDS) facilitates modifications to clinical documentation through concurrent interaction with physicians and other ... results, diagnostic information and treatment plans + Three years of previous clinical acute care nursing experience medical/surgical experience to include… more
- St. Luke's University Health Network (Bethlehem, PA)
- …mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care ... the communities we serve, regardless of a patient's ability to pay for health care . Provides comprehensive care of patients admitted to the inpatient acute… more