- Centene Corporation (Harrisburg, PA)
- …physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of ... management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality… more
- Aveanna Healthcare (Erie, PA)
- …Details POSITION SUMMARY Aveanna Healthcare's purpose is simple, to provide high quality clinical home care to medically fragile children so they can grow ... clinician, and within insurance authorization. - Responsible to manage utilization of direct care team members based... team member. - Prepares and distributes the patient/direct care team member schedule. Performs initial review … more
- Geisinger (Wilkes-Barre, PA)
- …top-notch care in an ambulatory setting. Job Duties Provides direct patient care and clinical support for physicians and other providers in the outpatient ... setting. Functions as an integral member of the health care team under the direction of the provider. Performs... team under the direction of the provider. Performs clinical duties such as preparing patients, collecting and reviewing… 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 ... UPMC Children's Hospital has fulfilled this mission since its founding in 1890.** The Care Manager (CM) coordinates the clinical and financial plan for patients.… more
- Penn Medicine (Philadelphia, PA)
- …health care , achieve clinically appropriate and financially sound resource utilization , support the insurance verification team, clinical staff and verify ... (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania State Licensed… 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 ... patients navigate the complex health system and that help reduce/remove barriers to care . Responsible for clinical support and coordination related to value… more
- Highmark Health (Pittsburgh, PA)
- …partners and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, ... utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but not limited to: physician… more
- Humana (Harrisburg, PA)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Guthrie (Sayre, PA)
- …leadership and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ... Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for… more
- Penn Medicine (Lancaster, PA)
- …is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more