- UPMC (Pittsburgh, PA)
- … clinical info with access reps and insurers for service authorization. + Review cases/groups and escalate serious clinical changes to Director as needed. + ... levels of care or community resources. + Maintain daily clinical productivity records. + Participate in quality ...assessments. + Lead staff in-service training and contribute to system -wide education initiatives. + Provide clinical and… more
- Penn Medicine (Philadelphia, PA)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... home care, DME, placements, hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization… more
- Evolent (Harrisburg, PA)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Provides clinical rationale for standard ... the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… 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 ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as… 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 ... Research will oversee research involving children throughout the Geisinger Health System . Working in partnership with researchers throughout the Geisinger Health … more
- Healthcare Services Group, Inc. (Bensalem, PA)
- …System Specialist position is a combination of program administration, quality assurance/process improvement and clinical /operational support services work, ... is currently seeking to fill the position of Menu System Specialist to join our growing Corporate Team in...accordance with corporate standards. + Support the bi-annual menu review process for each assigned division. + Identify and… 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
- 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 ... that are health plan and community-based (embedded into provider systems ) to deliver the highest quality of...quality of care to Highmark members and improve clinical documentation accuracy and completeness. Creates a culture focused… 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 ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...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 ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. . Aids and acts as… more