- Highmark Health (Natrona Heights, PA)
- …they know what to expect and understand their financial responsibilities. Assumes clinical and financial risk of the organization when collecting and documenting ... and forwards calls and calls patient to relay information. + Works charge review and claim edit workqueues + Proactively manages wait list + Schedules procedures… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …and ensuring compliance with all regulatory and quality standards. + Review , investigate, and document narcotic discrepancies daily; prepare weekly reports for ... director of pharmacy to ensure accurate and timely resolution. + Oversee the disposition process for all expired or damaged pharmaceuticals, ensuring proper documentation, regulatory compliance, and safe removal from inventory. + Support medication… more
- Evolent (Harrisburg, PA)
- …utilization management with collaborative engagement and innovation. **Core Responsibilities** + ** Clinical Review & Peer Collaboration** + Serve as the ... play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the… more
- J&J Family of Companies (Horsham, PA)
- …protocols, and/or scientific manuscripts preferred + Experience with data analysis and review , and/or clinical study execution as either an investigator or ... leading the development and execution of Medical Affairs sponsored and supported clinical programs for company products in the Gastroenterology Therapeutic Area and… 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...Will Be Doing:** . Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially… 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...Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet… 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 ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet… 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...Will Be Doing:** + Serve as the specialty match reviewer in Vascular cases, that do not initially meet… more
- Centene Corporation (Harrisburg, PA)
- …(BCBA) required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or assess ABA ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- EGA Associates (PA)
- …Physician Reviewers for Medicaid grievance cases. In this role, you will review clinical documentation and participate in member grievance hearings, providing ... **Required Certifications for Onboarding** AMA, DEA, NPI **Job Description** Physician Reviewer - Medicaid Grievance Hearings (1099 Contract Role) Location: Remote… more