- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Penn Medicine (Philadelphia, PA)
- …ongoing education and training on current trends in documentation and coding + Enter clinical review data and related anticipated follow-up in EPIC PENN Chart to ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Evolent (Harrisburg, PA)
- …and other CR's whenever input is needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not pass the ... staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description… more
- Evolent (Harrisburg, PA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Fresenius Medical Center (West Chester, PA)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Evolent (Harrisburg, PA)
- …work with the Director of UM to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory of the United ... responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of… more
- Pfizer (Collegeville, PA)
- …results + Support execution for all FIH programs through proof-of concept + Set the clinical data review strategy, ensure quality data and conduct review of ... emerging clinical data and trends; review and query data; present and discuss relevant data...and other internal and external stakeholders + Conduct data review , analysis and interpretation of clinical trials… more
- Edwards Lifesciences (Allentown, PA)
- …search strategies, manage associated documentation, and prepare literature summaries). + Independently review raw and summary clinical data for accuracy; resolve ... experience with maintaining current, in-depth product knowledge including current developments, clinical literature review , as well as therapeutic and product… more
- Highmark Health (Zelienople, PA)
- …coverage requests for both pharmacy and medical benefits and prepares such cases for clinical review when required. Within the context of the request, applies ... policies and guidelines. (40%) + Patient & Provider Coordination: Resolves non- clinical issues independently and acts as a liaison between customers, provider-facing… more
- Pfizer (Collegeville, PA)
- …supports preparations for Health Authority meetings, participates as appropriate. + Set the clinical data review strategy and leads the team in the collection ... of quality data and review of emerging clinical data and trends; reviews and queries data; presents and discusses relevant data to appropriate teams, governance… more