- Penn Medicine (Lancaster, PA)
- …is recruiting for a full-time inpatient Case Manager to join a team of dedicated Case Managers managing a variety complex cases. Case Managers on the ... complex team take cases referred from our unit based Case Managers._ _The Complex Team manages cases for patients who have a variety of challenges and… more
- UPMC (Pittsburgh, PA)
- …obtained from interaction with members and providers. + Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and ... use your nursing background in outpatient, home health, or case management? Do you have an interest in health...Medication Review as appropriate. + Refer members to appropriate case management, health management, or lifestyle programs based on… more
- UPMC (Pittsburgh, PA)
- …obtained from interaction with members and providers. Presents or contributes to complex case reviews by the interdisciplinary team, summarizing clinical and ... history, current medications, geriatric syndromes, healthcare resource utilization, and case management interventions. Updates the plan of care following review… more
- St. Luke's University Health Network (Allentown, PA)
- … resolution, and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including determining if appeal is ... Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office. + Monitors retro denials to ensure… more
- Humana (Harrisburg, PA)
- …metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The ... background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data… more
- Humana (Harrisburg, PA)
- …metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The ... background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data… more
- Humana (Harrisburg, PA)
- …metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The ... daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical… more
- Concentrix (Harrisburg, PA)
- …compliance is critical once fully ramped up + Gradually take on more complex case work (non-development related) + Escalate any requests requiring development ... tasks, handling 100-150 tickets daily. SLA compliance and accurate case documentation are critical. Prior Salesforce Service Desk and...daily + Track and document internal communications within each case + Adhere to SLA timelines, which vary by… more
- Sharecare (Harrisburg, PA)
- …of their members to ensure successful completion of member goals, while providing Complex Case Management and/or care management support through the duration of ... program in an appropriate and efficient manner by providing high-quality telephonic Case or Care Management with CareFirst members. The Care Manager partners with… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …efficiencies. Effectively shares knowledge with other team members through orientation training, case studies, consultation for complex cases. + Other duties as ... the easy part.Getting prescriptions to patients has become increasingly complex . When things get messy along the prescription journey,...ConnectiveRx better than the sum of its parts. The Case Manager's primary duty is to assist customers with… more