- 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 ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- 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...to complex clinical scenarios, review of all submitted clinical records , prioritization of daily work, communication of decisions to… more
- CVS Health (Harrisburg, PA)
- …or Internal Medicine / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy implementation. ... Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied … more
- CVS Health (Harrisburg, PA)
- …the ability to determine correct coding and appropriate documentation during the review of medical records . The CPC must also ensure that the state, federal and ... patterns or trends. Activities include: - Conduct a comprehensive medical record review to ensure billing is...(CPC). - 3+ years of experience reviewing and analyzing medical records to determine appropriate CPT and… more
- Fresenius Medical Center (Bethlehem, PA)
- …action plans in order to achieve USV quality standards. + Maintains integrity of medical records and other USV administrative and operational records . + ... procedure trays with all needed supplies and interventional equipment prior to procedure. + Cleans the procedure room including...to comply with USV policies and procedures for patient medical records and state regulations. + Participates… more
- WellSpan Health (Chambersburg, PA)
- …patient records to ensure accurate documentation of the patient's medical treatment. + Adheres to Health Insurance Portability and Accountability Act (HIPAA) ... responsibilities of membership in managed care. + Completes necessary paperwork, prior authorizations and/or scheduling of appointments for patients who are ordered… more
- Bayer (Philadelphia, PA)
- …diverse minds to make a real difference, there's only one choice.** **Senior Medical Science Liaison Cardiorenal Pennsylvania New Jersey** The Senior Medical ... trusted scientific expert and partner representing Bayer in the medical community through the dissemination of and education on...to drive a company car or pooled vehicle (driving record must meet guidelines base on the company's Risk… more
- Guthrie (Troy, PA)
- …benefit plans and related UM requirements preferred. Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization management ... coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement of patient care services. The… more
- CVS Health (Allison Park, PA)
- …as PHI (patient health information) protected under HIPAA * Experience with electronic medical records , eg, Epic preferred * Bilingual (Spanish) preferred * One ... care management setting preferred * Certified Pharmacy Technician (CPhT) or other medical /customer service certification is a plus * Prior experience handling… more
- Humana (Harrisburg, PA)
- …be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ million ... our most vulnerable members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training … more