- Evolent (Harrisburg, PA)
- …staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not pass the ... record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of… more
- Evolent (Harrisburg, PA)
- …staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not pass the ... record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of… more
- Fresenius Medical Center (Dallas, 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
- Highmark Health (Camp Hill, PA)
- …to internal stakeholders and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide clinical , ... markets. The incumbent is primarily accountable for the delivery of clinical analysis and strategies for Highmark customers, including healthcare consultants and… more
- Prime Therapeutics (Harrisburg, PA)
- …using clinical criteria. Makes approval recommendations on all services that meet clinical review criteria. Refers all cases not meeting clinical ... medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when further review is necessary. + Other duties… more
- YAI (Kulpmont, PA)
- …per BACB guidelines. + Contributes to the agenda of and participates in weekly clinical review meetings and assists with trainings when necessary. + Attends ... + Assists the Qualified Behavior Modification Professional (QBMP) in oversight of clinical functions of a Community Crisis Home (CCH) and/or Enhanced Behavior… more
- YAI (Kulpmont, PA)
- …home are being addressed. + The QBMP will attend and participate in the weekly/monthly clinical review . The QMP is responsible to contribute to the agenda and ... situations, and activities. + The QBMP will complete annual clinical Performance Evaluations. + The QBMP will meet regularly...training as necessary. + The QBMP will assume the clinical responsibilities of the Lead RBT in their absence.… more
- Prime Therapeutics (Harrisburg, PA)
- …and/or pharmacists. + Escalates requests to Pharmacist when request requires extensive clinical review or denial. + Researches, resolves and documents physician ... our passion and drives every decision we make. **Job Posting Title** Clinical Pharmacy Technician - Remote **Job Description** Evaluates and authorizes approval of… more
- Prime Therapeutics (Harrisburg, PA)
- …staff and/or pharmacists. + Escalates requests to Pharmacist when request requires extensive clinical review or denial. + Monitors telephone system to ensure ... our passion and drives every decision we make. **Job Posting Title** Clinical Pharmacy Technician Sr - Remote **Job Description** Evaluates and authorizes approval… more
- Highmark Health (Wexford, PA)
- …Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. ... facts, and cites applicable internal policies and guidelines. (20%) + Resolves non- clinical issues independently and acts as a liaison between our customer and… more