• Director Risk Adjustment, Coding & Quality

    Highmark Health (Pittsburgh, PA)
    …with all applicable guidelines, regulations and laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services ... (HHS), and others established at the state and federal levels. Drives efficient operational functions to achieve established Quality measures, STARS and HEDIS… more
    Highmark Health (08/08/25)
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  • Community Hospital Registration Associate…

    Penn State Health (Reading, PA)
    …information, and Medicare required information. + Complete all State and Federal regulatory requirements as determined by the type of visit and the patient's ... Department of Health regulatory components, accurate guarantor information, and Medicare required information. + Conduct full patient pre-registration and… more
    Penn State Health (08/27/25)
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  • Clinical Reviewer, Nurse

    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
    Evolent (08/19/25)
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  • Residency Program Coordinator - Full Time…

    Trinity Health (Philadelphia, PA)
    …oversight and direction from the Program Director and the Director of Medical Education, the Program Coordinator/Internal Medicine is responsible for the operational ... management of the accredited residency training programs and medical students. The position required a comprehensive and detailed understanding of national… more
    Trinity Health (08/08/25)
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  • Coding Auditor Educator

    Highmark Health (Harrisburg, PA)
    …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts… more
    Highmark Health (08/08/25)
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  • Rehab Supervisor (Full-time/Willow Street Pa.)

    Penn Medicine (Willow Street, PA)
    …years of clinical experience. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...excluded from participation in Medicare , Medicaid or any other federal or… more
    Penn Medicine (08/30/25)
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  • Registered Nurse (RN), OR Women and Babies…

    Penn Medicine (Lancaster, PA)
    …within 30 days of hire. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...from participation in Medicare , Medicaid or any other federal or… more
    Penn Medicine (08/29/25)
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  • Registered Nurse (RN), Wound Care, Full-Time (Day…

    Penn Medicine (Lancaster, PA)
    …within 30 days of hire. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...from participation in Medicare , Medicaid or any other federal or… more
    Penn Medicine (08/28/25)
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  • Lead Director Network Platform Solutions

    CVS Health (Harrisburg, PA)
    …Examples include ensuring data standards are synchronized across Medicaid and Medicare platforms, ensuring duals workflows are support across systems, ensuring duals ... and Key Performance Indicators are met, mange ad-hoc requests, and ensure compliance with regulatory requirements. + Demonstrate an ability to lead through influence… more
    CVS Health (08/24/25)
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  • Senior Analyst, Quality Management

    CVS Health (Harrisburg, PA)
    …to the development and execution of HEDIS strategy to ensure compliance and optimize performance in quality measurement initiatives. Responsibilities include: * ... data analysis to strategize and achieve operational targets for NCQA HEDIS and Medicare Stars * Provide analysis support for PIP reports to regulators, including… more
    CVS Health (08/24/25)
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