- Evolent (Harrisburg, PA)
- …Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... Director, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as… more
- WellSpan Health (Lewisburg, PA)
- …+ Resolves billing problems and/or receives insurance updates. + May review physician orders for supporting documentation. **Common Expectations:** + Answers ... as required. + Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards. + Participates… more
- Geisinger (Danville, PA)
- …enhance the quality of life of children through research, education, and clinical care innovation. + Collaborates with Quality Improvement on evaluating and ... College of Health Sciences, the Director will guide the expansion of clinical and translational research involving children and adolescents. This role is integral… more
- UPMC (Pittsburgh, PA)
- …Quality Assurance and Improvement: Participates in program activities to ensure quality and performance. * Clinical Documentation: Completes documentation on ... authorization. * Case Reviews: Periodically reviews cases and discusses significant clinical changes with the team. * Patient Assessment: Assesses and updates… more
- ChenMed (Philadelphia, PA)
- …directors to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required ... * Accountability for outcomes: The PCP demonstrates accountability for outcomes, strong clinical care, and cost-effectiveness for each patient in their panel of up… more
- Cardinal Health (Philadelphia, PA)
- …is a patient centered health organization, that is committed to operational and clinical excellence, comprehensive and high quality of care for its patients. ... utilize both their pharmacy operations and business skills in addition to clinical ambulatory pharmacy expertise, in a growing mission-driven community health center… more
- Highmark Health (Pittsburgh, PA)
- …submit table to CMS for reimbursement.Oversee operations to track and validate multi-pass quality review of validation leading up to external audit of Highmark ... the highest quality of care to Highmark members and improve clinical documentation accuracy and completeness. Creates a culture focused on Compliance and Core… more
- Evolent (Harrisburg, PA)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as… more
- Evolent (Harrisburg, PA)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. . Aids and acts as… more
- Evolent (Harrisburg, PA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with… more