- Humana (Harrisburg, PA)
- …have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key ... to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Evolent (Harrisburg, PA)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …and Pathophysiology/Disease Processes/Pharmacology required. . Works claim edits identified along with compliance of the Medicare Coverage Determinations ( MCD ) ... long-term success including education assistance, scholarships, and career training. With medical and dental coverage, access to childcare & fitness facilities on… more
- Guthrie (Sayre, PA)
- …values of the organization + Supports evidence-based medicine + Overseas Corporate Compliance Workplan, and Secondary Medical Necessity Reviewer program Other ... Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social Work. Provides leadership for interdisciplinary performance improvement… more
- Option Care Health (Audubon, PA)
- …and accreditation entities. Complies with reporting requirements, ensures policy and procedure, compliance and monitors and evaluates medical supply usage. + ... direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also...Patient management skills, the Nursing Process, the rules of Federal , state, and local regulatory entities that oversee and… more
- Aveanna Healthcare (Pittsburgh, PA)
- …nursing services in their locations. The Director of Nursing operates within federal , state, and local home health regulations and organizational policies and ... collaboration with operational team to promote acceptable staffing levels. Ensure compliance with Nurse Practice Act Evaluate, supervise and support clinical staff.… more
- Penn Medicine (Lancaster, PA)
- …practice experience preferred. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...not excluded from participation in Medicare , Medicaid or any other federal or… more
- Penn Medicine (Lancaster, PA)
- …development (GED) exam required. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie, ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...not excluded from participation in Medicare , Medicaid or any other federal or… more
- Sunrise Senior Living (Haverford, PA)
- …leading all day-to-day operations of the skilled nursing center in accordance with federal , state, and local standards and Sunrise Senior Living policies to promote ... operation of the skilled nursing center in accordance with current federal , state/provincial, and local laws and Sunrise standards, guidelines, and regulations.… more
- UPMC (Pittsburgh, PA)
- …address Member identified needs through other sources, including services provided under Medical Assistance, Medicare or private insurance, and other community ... provide for seamless coordination between physical, behavioral, and support services. Ensures compliance with all state and federal regulations and guidelines in… more