- Humana (Harrisburg, PA)
- …with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members of the Medicare ... are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides… more
- Veterans Affairs, Veterans Health Administration (Wilkes Barre, PA)
- …state to independently practice social work at the master's degree level. Case management responsibilities include: Clinical contact for high-risk Veterans ... Summary The incumbent, a professional Social Worker, functions as a Case Manager for the Suicide Prevention Program. The Suicide Prevention Program serves to… more
- WellSpan Health (Lancaster, PA)
- …Weekdays, daytime hours **General Summary** Coordinates admissions, insurance authorizations, clinical case management, and discharge planning for children ... of care. + Utilizes a structured interview tool to conduct an in-depth clinical assessment, and documents this using approved WellSpan Philhaven evaluation forms. +… more
- Trinity Health (Pittsburgh, PA)
- …primary function is to provide supervision and direction to team members; the Clinical Lead also provides psychotherapy, case management, and mental health ... QUALIFICATIONS:** + Master's Degree in Human Services and 1 year of clinical experience, preferably diagnosing and treating behavioral and psychiatric conditions. +… more
- UPMC (Pittsburgh, PA)
- …coordination of benefits, premium billing, data warehouse, reports, analytics, communications, clinical case management, and various end users. Improve and ... coordination of benefits, premium billing, data warehouse, reports, analytics, communications, clinical case management, and various end users. . Improve… more
- Guthrie (Sayre, PA)
- …departments, including but not limited to Nursing, Imaging, Pharmacy, Patient Safety, Clinical Data Informatics, Clinical Systems, Case Management, ... Regulatory Compliance, Population Health, Value Based Reimbursement, Policy Management, Clinical Service Departments and other clinical leaders to lead, develop,… more
- UPMC (Pittsburgh, PA)
- …from interaction with members and providers. Presents or contributes to complex case reviews by the interdisciplinary team, summarizing clinical and social ... in clinical , utilization management, home care, discharge planning, and/or case management preferred. + Excellent organizational skills. High level of oral and… more
- Humana (Harrisburg, PA)
- …+ Experience advocating for managed care members at all levels of care. + Non- clinical Case Management experience + Call Center Experience + Experience working ... of care management in coordination with the RNs, Social Workers and non- clinical associates on this team. Responsibilities include: + Using knowledge of social… more
- Devereux Advanced Behavioral Health (Malvern, PA)
- …as well as neighboring states. Our treatment team, which includes psychiatrists, clinical case managers, nurses, teachers, licensed psychologists and clinical ... social workers, along with the family and child, work together to create a safety, stabilization and treatment plan that focuses on a successful discharge of the child back to his or her community, or lesser level of care. The majority of children stay at… more
- Penn Medicine (Lancaster, PA)
- …field staff through verbal and written means. *Closely collaborates with hospital providers, case management, home health clinical field staff, and home health ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more