- Humana (Harrisburg, PA)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex to complex...skills + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management,… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the… more
- Allied Universal (Pittsburgh, PA)
- …we serve. We offer comprehensive benefits for most full-time positions, including medical , dental, and vision coverage, life insurance, a retirement plan, employee ... perks, and more. **Security Custom Protections Officer Needed at Grove City Medical Center** **Full-Time - $19.00 / Hour** **7:00AM-3:00PM / 3:00PM-11:00PM /… more
- Veterans Affairs, Veterans Health Administration (Altoona, PA)
- …data elements related to the tumor registry. Perform duties autonomously. Search medical records to identify and abstract/code information. Organize and maintain the ... the Solid Tumor Rules manual. Keeps abreast of new medical terminology and revisions to the above manuals. Utilizes...[(Cancer Registrar)] who are appointed on a temporary basis prior to the effective date of the qualification standard… more
- City of Pittsburgh (Pittsburgh, PA)
- …eligibility list for this position . Candidates who receive job offers must pass a medical examination (when applicable) prior to start date. + Written : None ... people to be healthy and safe while homeless through case management, referrals to services, addressment of daily living...be or become residents of the City of Pittsburgh prior to employment and remain a resident throughout employment.… more
- CVS Health (Harrisburg, PA)
- …Lead team meetings and serve as the first point of contact for complex case issues or challenges. + Support hiring, onboarding, and ongoing talent development of ... + Build and maintain relationships with stop loss carriers to support case resolution and negotiation efforts. + Clearly articulate Meritain's services, underwriting… more
- Commonwealth of Pennsylvania (PA)
- …in the automated system and client records; reviewing and evaluating the medical appropriateness of psychiatric and/or behavioral health and substance abuse cases ... of care with other Clinical Care Reviewers, and completing referral and case documentation in accordance with program standards. You will conduct follow-up on… more
- Select Medical (Harrisburg, PA)
- …keep the hospital financially viable. + Communicate relevant data to clinical liaisons, case managers, prior authorization team, and physicians to help prepare ... Life** You will be a champion of The Select Medical Way, which includes: putting the patient first, helping...consent to treat forms and file. **Qualifications** **Qualifications** + Prior experience in a hospital, physician practice or insurance… more
- CVS Health (Harrisburg, PA)
- … Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical … more
- Guthrie (Troy, PA)
- …coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement of patient care services. The ... Care Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to assist… more