- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- Humana (Harrisburg, PA)
- … first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- UPMC (Pittsburgh, PA)
- …assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and ... care coordination? Check out this fantastic new opportunity! UPMC Health Plan is hiring a full-time Telephonic Care Manager...hiring a full-time Telephonic Care Manager to support the Medicare line of business within the Allegheny Care Management… more
- BAYADA Home Health Care (Bethlehem, PA)
- …The successful Physical Therapist or Occupational Therapist should have prior experience in Medicare Home Health . This position offers the successful ... care + Ensure adherence to policies and procedures + Review clinical documentation, including OASIS and care plan coding...experience + Prior clinical and managerial experience within a Medicare Certified Home Health agency… more
- Aveanna Healthcare (Bala Cynwyd, PA)
- …the best care possible! This Aveanna branch services the pediatric unskilled population and provides Home Health Aide services to our clients in the home ... (Nursing Supervisor) Aveanna Healthcareis a leading national provider of home health services to medically fragile children... through "Start of Care Assessments" and "Re-evaluations" + Review physicians' orders and update the plans of care… more
- Humana (Harrisburg, PA)
- …management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience ... focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient… more
- WellSpan Health (Gettysburg, PA)
- …members as directed by providers (ie VIS sheets etc.). + Obtains comprehensive health information from patient/family members to review with providers or ... at the time of the visit. This may include review of systems and history of present illness and/or...than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization… more
- WellSpan Health (Chambersburg, PA)
- …encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central ... Bonus Eligible_** **Join the professional environment at WellSpan Behavioral Health Outpatient Services in Chambersburg, PA.** The team is...+ Potential hybrid work schedule to include work from home and work in the office hours **What we… more
- WellSpan Health (Hanover, PA)
- …from the provider regarding results and follow-up instructions. + Obtains basic health information from patient/family members to review with providers or ... encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central… more
- WellSpan Health (York, PA)
- …encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central ... work related to the coordination of care of Behavioral health patients. + Maintains an awareness of community resources...crisis calls and service inquiries. + Visual ability to review and prepare written information and to observe patient… more